December 14, 2009

Unsure LMP


a) Neagele’s rule

b) Investigation

c) Management

d) Induction of labour

e) Complication of prostin

Neagele’s rule

1) Menstrual cycle is regular of 28 days (ovulation occur 14 days prior to the next menses)

2) Not on any form of hormonal contraception within 3 months

3) Not lactating within 2 months

4) Sure of date


1) Cardiatocography (CTG) to access fetal well being

2) Ultrasound for physical biometry of the baby, and amniotic fluid index

3) Biophysical profile of the baby


1) Confirmation of the date of pregnancy

a) Early ultrasound scan (<20w)

b) 1st UPT positive (6-8w)

c) Quickening

d) Uterine size correspond to pregnancy

e) Onset of signs and symptom of pregnancy

f) Conception date

2) Bishop score (>5 is favourable)

3) Elicit any medical problem.

Induction of labour

An intervention designed to artificially initiate uterine contractions leading to progressive dilatation and effacement of the cervix and the birth of the baby. The term is usually restricted to pregnancies at gestations greater than the legal definition of fetal viability (24 weeks).

Divided into mechanical (Sweep&scratch, ARM,) and pharmacological (IV Syntocinon, Prostin).

Others; breast stimulation, relaxin, hyaluronidase, sexual intercourse, acupuncture, homeopathic method

Indication for IOL

1) Fetal



c) GDM at 38w

d) Post EDD

e) Twin at term

f) Hx of unexplained APH

g) Transverse oblique/unstable lie

h) Hemolytic disease

i) Fetal abnormality incompatible with life (anencephaly)

2) Maternal

a) Medical disorder aggravated by pregnancy like DM, SLE, PE, Renal disease.

b) IUD with risk of DIC

c) Spontaneous/ PROM>24h

d) Abruption of placenta

Complication of prostin

1) Failed IOL (require c-sec)

2) Uterine hyperstimulation

3) Uterine rupture.

4) C/I in patient with asthma/glaucoma

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