1. Teaching obstetrics in English Xuming Bian, M.D. Department of Obstetrics & Gynecology Peking Union Medical College Hospital

2. New challenge Lack the exposure and concept in terms of lecturing in English

3. Find the difference prepare prepare How can do it better

4. Main difference of teaching medicine In Chinese: Only new knowledge In English: New medical knowledge and Language ability

5. Goal Learn new knowledge Improve English

6. Prepare – most important New medical term Outline Discussion

7. Pregnancy embryo fetus placenta amniotic fluid New term

8. Gestation week and gestation age 1 st trimester 2 nd trimester 3 rd trimester

9. Documentation of gestation age Menstrual history Reliable last menstrual period Date of first positive pregnancy test Pelvic examination prior to 12 wk Fetal movement (quickening) at 16 wk Ultrasound exam prior to 20 wk Uterine fundus reaching the umbilicus at 20 wk

10. Antenatal check – normal pregnancy Before 28 wk : once / month 28 - 36 wk : once/ 2 wks After 36 wk : once / 1 wk

11. Special examination U/S in 1 st trimester 20wk 32wk 38wk Screening test for chromosome abnormalities and NTD Amniocentesis Pap smear (TCT) Screening test for GDM Vaginal culture

12. Normal labor and delivery 1 st stage 2 nd stage 3 rd stage

13. Exam during labor Vaginal exam - cervix - fetal presentation - amniotic membrane Fetal monitoring

14. Operative delivery Vacuum extraction Forceps Cesarean section

15. Complication of pregnancy Spontaneous abortion Hyperemesis gravidarum Ectopic pregnancy Preterm labor Premature delivery Prolonged pregnancy Premature rupture of membranes (PROM)

16. Complication of pregnancy Pregnancy induced hypertension (PIH) Gestational diabetes mellitus (GDM) Fetal growth restriction (FGR) Small for gestational age (SGA) Placenta previa Placental abruption

17. Abortion Definition: termination of pregnancy when g.a.  28wk ， fetal weight  1000g. Stage early late g.a. 12 28 10%  15% of all of the pregnancy are miscarriage. 80% of miscarriage is in early stage.

18. Classification of abortion Induced abortion Spontaneous abortion (miscarriage) Threatened abortion Inevitable abortion Incomplete abortion Complete abortion Missed abortion Habitual abortion Septic abortion

19. Etiology of miscarriage Etiology of miscarriage Embryo factors: abnormal chromosome Maternal factors: –Systemic disease (high fever, heart failure, anemia, hypertension, malnutrition) –Endocrinology (Luteal Phase Deficiency, hypothyroidism, DM) –alloimmune (Rh isoimmunization, ACL) –Incompetent internal cervical os, uterine malformation –Psychological factors, operation, trauma, alcohol, drug Environmental factors

20. Ectopic pregnancy Fertilized ovum implants on any other than the endometrium, 80  90% occur in the fallopian tube. Symptom—amenorrhea, abdominal pain and abnormal vaginal bleeding Natural course—abortion, rupture, persistent and abdominal pregnancy

21. Diagnosis of ectopic pregnancy Ultrasound no g.s in the uterus, adnexal mass, fluid in the cul-de-sac. Quantitative assays of  -hCG culdocentesis Uterine curretage Pay attention to the atypical EP

22. Management of ectopic pregnancy Volume resuscitation Salpingectomy or salpingostomy via laparoscope or by laparotomy Nonsurgical methods, MTX 50mg/m 2, mass  3cm,  -hCG  2000IU/L, no heart beat, no contraindication

23. Hyperemesis gravidarum Excessive nausea and vomiting before 20 wk Ketonuria, dehydration, Vitamine B1 deficiency Admit to the hospital, parenteral nutrition

24. Pregnancy induced hypertension-1 Hypertention, edema and proteinuria after 20 wk. Pathophisiology: generalized vasospasm Classification: mild PIH, preeclampsia, eclampsia, superimposed PIH, chronic essential hypertension

25. Pregnancy induced hypertension-2 Symptom and sign: Hypertention, edema, headache, visual blurring, epigastric pain Test: CBC, liver and renal function, urine protein, 24-hour urine protein, optic fundi, U/S, NST,

26. Pregnancy induced hypertension-3 Treatment: bed rest, monitoring, magnesium sulfate (MgSO 4 ), antihypertensive medication, prompt delivery MgSO 4 : 4g loading dose followed by a maintenance dose of 1-1.5g/hr. Magnesium toxicity: patellar reflex, respiration, urine output, serum Mg level, calcium gluconate is the antidote

27. Pregnancy induced hypertension-4 HELLP syndrome –Hemolysis –Elevated Liver enzyme –Low Platelet syndrome Eclampsia: convulsion, coma

28. Preterm labor Regular uterine contractions accompanied by a change in effacement or dilatation of the cervix before 37 wk Tocolysis: beta-agonist drugs – ritodrine, MgSO4, calcium agonist, indomethacin, lidocaine Glucocorticoids: dexamethasone in four doses of 6mg im Q12h

29. Prolonged pregnancy Truly extends beyond 42 wks of confirmed gestational age Fetal well-being: NST/CST/OCT, U/S (oligohydramnios) Cervical ripening followed by induction of labor, C/S

30. Premature ruptured membranes PROM: the rupture of membrane prior to the onset of labor at term PPROM:  37 wk Intrauterine infection (chorioamnionitis) Expectant management, pregnancy termination

31. Gestational diabetes mellitus-1 Screening test: 50-g glucose, 1-hour interval, 7.8mmol/L Diagnosis test: 3-hour glucose tolerance test, 5.6, 10.3, 8.6, 6.7 mmol/L Impaired glucose tolerance (IGT): one value, GDM: two or more values exceeding these levels

32. Gestational diabetes mellitus-2 Glucose control: diet, exercise, insulin Macrosomia, fetal anomalies, shoulder dystocia, fetal distress Delivery before 40 wk because of fetal lung maturation and fetal distress

33. Fetal growth restriction -1 Fetal birth weight  10 th percentile Symmetric, asymmetric Etiology: abnormal karyotype, intrauterine infections, maternal condition, placental abnormalities Small for gestational age (SGA)

34. Fetal growth restriction - 2 U/S: estamination of fetal weight, oligohydramnios, elevated Doppler S:D ratios Treatment: bed rest in the left lateral position, oxygen, intravenous nutrition, fetal assessment

35. Placental previa Abnormal implantation of the placenta Total, partial, marginal, low-lying placenta Vaginal bleeding without uterine contraction, anemia, abnormal lie Expectant management, tocolysis, fetal monitoring, C/S

36. Placental abruption-1 Vaginal bleeding, uterine hypertonia, fetal distress Maternal hypertension, trauma Mild, moderate and severe Back pain, uterine tenderness U/S: retroplacental hematoma

37. Placental abruption-2 Complication: hemorragic shock, DIC, ischemia necrosis of vital organs Lab: CBC, PT+A, liver and renal function Treatment: oxygen, Foley catheter, blood and volume replacement, fetal monitoring, timing and mode of delivery

38. Discussion How much you can understand Advantage and disadvantage How to improve

39. Thanks for your attention!