[Intro: 145 BPM. A rapid, hollow woodblock rhythm starts immediately. A deep, sub-harmonic throat-singing drone fades in, vibrating the floor. The upbeat reggae guitar skank joins the groove. The Reggae MC hypes the rhythm.] [Verse 1: Fast-chatting flow. The woodblocks tick furiously as the MC rides the pocket.] shoulder! M. C. Roberts Shoulder dystocia; episiotomy, McRoberts maneuver “suprapubic pressure hip & knee flexed”, if fail “Rubin, Woods, all-fours, break anterior clavicle, Zavanelli back to the cesarean”. Erb's palsy risk. Turtle sign. Turtle sign! Cord prolapse Overt Cord prolapse; knee-chest position, apply upward pressure against the presenting part, instill saline into the bladder, cesarean. cesarean! If occult prolapse; lateral Sims or Trendelenburg, oxygen, amnioinfusion, last stop cesarean [Verse 2: The throat singing drops to a guttural growl. The reggae bassline gets heavy and bouncy.] Pemphi, Pemphi, Pemphi, goid! Pemphigoid Gestationis; pruritic papules and urticarial plaques then vesicles/bullae frequently involve umbilicus. topical corticosteroids and oral antihistamines. If fail, oral steroid. Prurigo go go go of pregnancy “pruritic red papules on extensor surfaces, trunk”. Antipruritics, if fail, oral steroid. (oral steroid!) Pruritic urticarial papules and plaques of pregnancy: Erythematous pruritic papules/plaques; patchy or generalized, especially within striae, but with umbilical sparing. Antipruritics, if fail, oral steroid [Bridge / Rapid Fire Section: The woodblock goes into overdrive. The MC chants the massive symptom list with breathless speed, perfectly in time with the skank.] Mellitus, DM DM A.S.A.P. Diabetes; “preterm birth, Fallot tetralogy, A.V. septal defect, coarctation, neural-tube defects, cleft palate, hypospadias, macrosomia, hydramnios, hypertrophic cardiomyopathy , hypoglycemia and hypocalcemia, polycythemia, R.D.S. drinking is dangerous! Fetal alcohol syndrome; intellectual disability, midfacial hypoplasia, smooth philtrum, cardiac defects Hydantoin syndrome; “hypertelorism, low nasal bridge, midface hypoplasia; hypoplastic distal phalanges; growth impairment; and intellectual disability hypoplastic phalanges! [Chorus / Breakdown: The reggae beat halves its feel, letting the deep throat singing take center stage. The MC delivers the lab values with rhythmic emphasis.] Down ! Down; “high h.C.G. & inhibin, low Papp-A., alpha feto and estriol; Nuchal translucency” Trisomy 18; M.S.A.F.P., h.C.G., estriol all decreased. All! Cholestasis Intrahepatic Cholestasis of Pregnancy; “pruritus, jaundice, or both”. Antihistamines, ursodeoxycholic acid (ursodeoxycholic acid!) Fatty Liver ! Acute Fatty Liver of Pregnancy; “abnormalities of fatty acid oxidation in mitochondria”, manifests in the last trimester, nausea vomiting, epigastric pain, jaundice, encephalopathy, abnormal Liver., coagulopathy, Acute kidney. Treat! Supportive measures and delivery [Verse 3: The fast-paced 145 BPM groove kicks back in fully. The woodblocks clack wildly.] Vasa previa; prenatal diagnosis, C.-section at 35 weeks. “ruptured membranes, painless vaginal bleeding and fetal distress” Apt test ! Bacteriuria ! Asymptomatic Bacteriuria in pregnancy; “Fosfomycin, Nitrofurantoin & sulfonamides ”. Amoxicillin/ampicillin - high resistance Endometritis; fever, abdominal pain, parametrial tenderness, leukocytosis. Clindamycin and gentamicin clinda and genta! [Outro: The guitar and bass drop out. Only the rapid woodblock, the MC's voice, and the haunting throat singing remain.] do not lactate! drug usage, uncontrolled alcohol use; galactosemia; H.I.V.; active, untreated tuberculosis; medications 'cytotoxic'; breast cancer treatment H.S.V. breast lesions! [Ending: A final, loud woodblock strike. The throat singing drone holds for five seconds, slowly fading into total silence.]
