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2016年10月13日 星期四

[醫如往常] Senior Clerkship Day 29: Ob/Gyn

柯教授
Amniocentesis 五十萬例
CVS(Chorionic Villus Sampling) 一萬例
從不開預防性抗生素,無菌操作比較重要
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前三個月死亡率最高
25% of all

Ga 16w, aminocentesis only 2% anomaly
Newborn 0.5%
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Chromosome abnormally 70%, >5 Mb
  • 50% Numerical, trisomy 16, 22 最常見
  • 50% Structural, balanced, unbalanced
Genetic, <5Mb, DiGeorge syndrome most common
Single gene, >1bp

Cytogenic
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30% pregnancy bleeding
Douglas pouch
15% vaginal bleeding
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NIPT 10% free-DNA
Screen

Nuchal translucency >3mm
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Taiwan
15%>34yo
Used to be 8% 30 years ago.
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CVS Ga>10w
Aminocentesis >16w
Fetal blood sampling >20w
CVS其實比較安全
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NIPT 0.3% 無法檢測到
Aminocentesis 0.1%, 本來就會流產
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避孕器 aminocentesis 可能感染

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大破水還是有50%沒事
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45xo with SRY translocation
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At least 100 de novo mutation
97%是突變,不是遺傳

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林助教授
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1.Goodell sing:子宮頸變軟。2.Chawuck sing: 子宮頸、陰道黏膜會陰部黏膜變紅紫或深藍色。
3.Hegar sign:子宮峽部變軟(及介於子宮頸與子宮體間部,在6~8週會變軟)。
4.Ladin sign:子宮前面正中處,有一柔軟的點出現。
5.Mc Donald sign:指屈曲子宮頸底部時沒有阻力,使子宮底易於屈曲而接觸子宮頸。
6.Braun von fernwald sign:妊娠第五週,受精卵著床處變軟,增大使子宮呈不規則球形。
7.Piskacek sign:指腹部似種瘤呈不對稱腫大。
8.Physiologic erosion:生理性糜爛、因局部血流增加,組織變軟易生糜爛屬生理變化。
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Parikh's formula is a calculation method that considers cycle duration. Naegele's rule assumes an average cycle length of 28 days, which is not true for everyone. EDD is calculated using Parikh's formula by adding nine months to the start of the last menstrual period, subtracting 21 days, then adding duration of previous cycles.

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