[Intro: Free Tempo. The sharp clack-clack of wooden Hyoshigi rings out. A lone Shamisen plays a tense, bending melody. The Joruri Chanter opens with a theatrical, trembling wail before the hip-hop beat drops in at a heavy 90 BPM.] [Block 1: The J-Rapper steps up, flowing rapidly over the heavy kick and Shamisen loop, enunciating every symptom with rhythmic precision.] (J-Rapper) Preeclampsia Pre Preeclam Preeclampsia; hypertension with proteinuria. For eclampsia or severe preeclampsia; “anticonvulsant & antihypertensives , followed by delivery” Without severe features; “delivery at 37th weeks” H.E.L.L.P. syndrome Postpartum hemorrhage “mostly uterine atony”; massage, fluids, oxytocin, methylergonovine, misoprostol, tranexamic acid, balloon tamponade, surgery. If cause is lacerations “repair” [Block 2: The beat strips back to just a rim-click. The flow becomes more aggressive and urgent to match the severity of the text.] (J-Rapper) * Uterine inversion due to “abnormal placental implantation , uterine atony, cord traction before placental separation. Shock, hemorrhage uterus visible at the cervix, or fundus depression if incomplete Uterine rupture "hydramnios, trauma, accreta" “loss of station, nonreassuring fetal heart rate pattern, abdominal pain, hemorrhage”. Emergent cesarean and exploratory laparotomy Amnionic Fluid Embolism; rapid cardiorespiratory collapse and consumptive coagulopathy [Block 3: The hip-hop beat halts. The Joruri Chanter takes over, delivering the placental complications as a slow, dramatic, traditional recitation, punctuated only by Shamisen strikes.] (Joruri Chanter) * Placental abruption ; sudden abdominal pain, bleeding. Emergency cesarean, if fetus nonviable “vaginal birth” Placenta previa; “painless bleeding”. Transabdominal sonography. If bleeding subsises and fetus is immature then observation. Scheduled cesarean (36-37 week) Placenta accreta; cesarean 34 ± hysterectomy; if no U.S.G. diagnosis “postpartum hemorrhage.”; associated with placenta previa [Block 4: The beat drops back in, faster and more energetic. The J-Rapper rides the pocket effortlessly.] (J-Rapper) Preterm birth; “corticosteroids, magnesium sulfate for neuroprotection, tocolytics for 48 hours (allow steroids to work; Mg sulfate, terbutaline, nifedipine, indomethacin), no bed rest” P.P. R.O.M.; “sudden gush of fluid” speculum examination ; after 37, deliver/G.B.S./infection treatment; before 34, expectant/steroids/tocolytics/Mg. Before 22 consider terminancy If chorioamnionitis "fever, leukocytosis, uterine tenderness, foul smell"; “deliver”. Use antibiotics (ampicillin + erythromycin) for preterm P.R.O.M. Cerclage Cerclage Cerclage placement for cervical insufficiency, short cervix (asymptomatic or in cervical insufficiency) Cervical insufficiency, in the second trimester, painless cervical dilation Progesterone for short cervix, short, cervix [Block 5: A deep sub-bass joins the Shamisen. The Joruri Chanter and J-Rapper alternate lines, blending the ancient and the modern.] (Joruri Chanter) Rh alloimmunization; screen first prenatal visit. If Rh-negative & unsensitized (negative Ab) “give anti-D now and 40th week, within 72 hours after delivery (if the newborn is D-positive)”. If sensitized follow with M.C.A. Dopplers, if low “delivery if not possible, transfusion” (J-Rapper) 3-5 3 4 5 contractions or total of 200-250 Montevideo in 10 minutes 6 cm dilation - start of the active phase. Arrest “no more cervical dilation despite 4 hours adequate contractions or 6 hours of inadequate with oxytocin”. Cesarean delivery (operative vaginal may be assessed) Prolonged second stage >3 hours of pushing in nulliparous >2 hours in multiparous For long latent phase (>20 hours in nullipara >14 hours multipara) “treated with amniotomy and oxytocin” [Outro: The J-Rapper finishes the track a cappella, except for a final, frantic Shamisen solo building tension underneath his words.] (J-Rapper) Induction augmentation augmentation Induction Induction means stimulation of contractions before the onset of labor (vs augmentation). “When the benefits to either mother or fetus outweigh those of pregnancy continuation. Indications; membrane rupture without labor, gestational hypertension, oligohydramnios, non-reassuring fetal status, post-term, chronic hypertension and diabetes Bi shop shop Bishop score above 8; likely a successful induction Techniques: Oxytocin, misoprostol, amniotomy, transcervical Foley placement, hygroscopic cervical dilators, membrane stripping [Ending: A massive, echoing strike of the Hyoshigi clappers. A final, dissonant Shamisen twang. Total silence.]
