Late onset Intra Uterine Growth Restriction occurs after 32 weeks of gestation
It is usually caused by uteroplacental insufficiency
The various etiologies proposed in the development of delayed onset IUGR are:

hypertension
pre eclampsia
diabetes mellitus
maternal malnutrition

Late in pregnancy, the fetus grows mainly by cellular hypertrophy rather than hyperplasia and hence late onset IUGR is more amenable to therapy
The abdominal circumference will be much lower than normal as the deposition of glycogen in liver is impaired
The head circumference will be almost normal due to the brain sparing effect

Sibai regimen is an intravenous magnesium sulphate regimen for treatment of eclampsia
It was introduced by Sibai et al in 1990
Loading dose – 6g IV given over 20 minutes
Maintenance dose – 2-3g IV every hour

Maternal and fetal outcome after treatment with Sibai regimen:

In a study published by Sibai et al in 1990, treatment of eclampsia with Sibai regimen had a maternal mortality of 0.5% and a perinatal mortality of 5%.

Zuspan regimen is a treatment regimen using Magnesium sulphate for the treatment of eclampsia
Magnesium sulphate 4g is given as IV bolus dose in the beginning
This is followed by intravenous infusion of Magnesium sulphate at the rate of 1g/hour till 24 hours have elapsed after the last seizure
Other regimens using MgSO4 for treatment of eclampsia are

Pritchard’s regmimen
Sibai regimen

HELLP stands for:

Hemolysis, Elevated Liver enzymes, and Low Platelets

The hour following delivery of placenta  is termed Fourth stage of labour
Monitoring of the patient’s Blood pressure and pulse rate during this stage is important
The episiotomy site should be checked for bleeding or development of any hematoma
Check whether the bladder is distended, if so encourage patient to pass urine
If the patient is stable after one hour and has passed urine, she can be transferred to the post natal ward

Oxytocin is a polypeptide hormone synthesised by the supraoptic and paraventricular nuclei of hypothalamus
It is secreted by the posterior pituitary into the blood stream

Actions of oxytocin

Main action is on uterine myometrium

It promotes uterine muscle contraction
The action is greater on pregnant uterus as it has increased number of oxytocin receptors

Contraction of myoepithelial cells in breast cause expression of breast milk
Smooth muscle relaxation and vasodilation
ADH (Anti Diuretic Hormone) like effect in large doses, causes water intoxication

Mechanism of action on uterine myometrium:

It acts by releasing cAMP
This in turn results in the release of …

Partogram is a graphical representation of the progress of labour depicting cervical dilatation and station of head plotted against time
The concept of partogram was first introduced by Friedman

Data recorded in a partogram are:

Patient data – Name, Age, Parity, Hospital identification number, Date of admission, Time of admission
Dilatation of cervix
Station of fetal head
Fetal heart rate
Number of uterine contractions in 10 minutes
Moulding (+ / ++ )
Liquor amni

Intact membranes – I
Clear liquor – C
Meconium staining – M

Oxytocin units, drops/min
Drugs
Oral and IV fluids
Blood pressure, pulse, temperature
Urine for acetone

How to use a partogram in active management …

Artificial rupture of membranes (ARM) is the process in which the foetal amniotic sac is ruptured to facilitate labour
It is usually done once the active stage of labour begins
The membranes are ruptured using Kocher’s forceps
The liquor should be examined for meconium staining

Meconium staining of liquor indicates foetal distress

Once ARM is done, foetal heart rate should be checked

Transient changes may occur due to pressure on the cord by the foetal parts that change position once the liquor is drained
Prolonged changes in foetal heart rate indicates foetal distress
When associated with bleeding, it …

ARM stands for

Artificial Rupture of Membranes (amniotomy)

Part of pelvis above the linea terminalis
Obstetric function – support of gravid uterus during pregnancy