DR. AKOON BOL, Blackdoctor@facebook. com, Juba (2026)

14/07/2026

ANTICOAGULANTS vs. ANTIPLATELETS vs. THROMBOLYTICS

They’re NOT the same thing.

Let’s stop calling every medication a “blood thinner” because each works differently.

Think of them as three levels of clot management.

1️⃣ Anticoagulants

Anticoagulants work by interfering with the coagulation cascade, slowing the formation of fibrin and blood clots.

They do not dissolve existing clots.

Their purpose is to:
✅ Prevent new clots from forming.
✅ Prevent existing clots from getting larger.

They are commonly used for conditions involving blood stasis, such as:
• Atrial fibrillation (AFib)
• Deep vein thrombosis (DVT)
• Pulmonary embolism (PE)

Memory Trick: Anti-coagulant = Against clotting.

2️⃣ Antiplatelets

Antiplatelets work on platelets, preventing them from sticking together and forming a platelet plug.

They are commonly used when platelet activation is the main problem, especially after endothelial injury, such as:
• Coronary artery disease (CAD)
• Heart attack (MI)
• Stroke prevention
• After coronary stent placement

Memory Trick: Aspirin = Slippery platelets.

3️⃣ Thrombolytics

Thrombolytics are the most aggressive of the three.

Unlike anticoagulants and antiplatelets, they actively dissolve an existing blood clot by breaking down fibrin.

These medications are used in selected emergencies such as:
🚨 Acute ischemic stroke (when eligible)
🚨 ST-elevation myocardial infarction (STEMI) when PCI is unavailable or delayed
🚨 Massive pulmonary embolism with hemodynamic instability

Many thrombolytics end in ”-ase” (e.g., alteplase, tenecteplase).

Memory Trick: Thrombolytic = Tears the clot apart.

✅ Quick Recap

🩸 Anticoagulants → Against clotting (prevent new clots and stop existing clots from growing)

🩸 Antiplatelets → Slippery platelets (prevent platelets from sticking together)

🩸 Thrombolytics → Tear the clot apart (dissolve an existing clot)

10/02/2026

Trial of labor after cesarean section (TOLAC) Presentation today in Obs & Gynae department at Juba Teaching Hospital.

03/02/2026

Cranial Nerves (12 Pairs)

I. Olfactory (Sensory)
Function: Smell
Lesion: Loss of smell (Anosmia)

II. Optic (Sensory)
Function: Vision
Lesion: Blindness, visual field defect

III. Oculomotor (Motor)
Function: Eye movement, pupil constriction
Lesion: Ptosis, dilated pupil

IV. Trochlear (Motor)
Function: Eye movement (down & inward)
Lesion: Difficulty looking down

V. Trigeminal (Both)
Function: Facial sensation, chewing
Lesion: Loss of facial sensation, weak mastication

VI. Abducens (Motor)
Function: Lateral eye movement
Lesion: Inability to move eye laterally

VII. Facial (Both)
Function: Facial expression, taste (anterior 2/3 tongue)
Lesion: Bell’s palsy

VIII. Vestibulocochlear (Sensory)
Function: Hearing & balance
Lesion: Deafness, vertigo

IX. Glossopharyngeal (Both)
Function: Taste (posterior 1/3), swallowing
Lesion: Loss of gag reflex

X. Vagus (Both)
Function: Parasympathetic control of heart, lungs, GIT
Lesion: Hoarseness, dysphagia

XI. Accessory (Motor)
Function: Shoulder & head movement
Lesion: Weak shoulder shrug

XII. Hypoglossal (Motor)
Function: Tongue movement
Lesion: Tongue deviation

Important Exam Points ⭐
Total cranial nerves = 12 pairs
Sensory only: I, II, VIII
Motor only: III, IV, VI, XI, XII
Both (Mixed): V, VII, IX, X

Mnemonic (Names):
Oh Oh Oh To Touch And Feel Very Good Velvet AH

Mnemonic (Function):
S S M M B M B S B B M M

.Nusia

31/01/2026

STAGES OF FETAL DEVELOPMENT

1st Trimester (Weeks 1–12)
• Baby’s organs begin to form
• Heart starts beating
• Arms, legs, and face develop

2nd Trimester (Weeks 13–26)
• Baby starts moving and kicking
• Gender may be seen on ultrasound
• Hearing and reflexes develop

3rd Trimester (Weeks 27–40)
• Baby gains weight and fat
• Lungs and brain mature
• Baby gets ready for birth

👉 Every stage is a miracle in progress. 💕

.Nusia

29/01/2026

THE PARTOGRAPH.
Definition of a Partograph
A partograph is a tool used by the midwife/obstetrician to monitor the progress of labour and be able to detect any deviation from normal as early as possible.
The following information regarding labour is recorded on the partograph.

PERSONAL PARTICULARS
Name
Gravid
Parity
Date of Admission
Time of Admission
Hospital Number
Time membranes ruptured

PROGRESS OF LABOUR
A partograph is opened when cervical dilatation is 4cm or more. It has 2 diagonal lines.
The alert line (alerts us)
This is the 1st line. It represents the active phase of labour. It is drawn at 4cm dilatation to a point at the top of the graph which will represent full dilatation.

The cervix dilates to a minimum of 1cm/hour in primi-gravida and 1.5cm in multi-gravida

This line alerts the midwife/Doctor to the fact that progress of labour is abnormal when the readings cross this line.
Action line (action needs to be taken)
This is the 2nd line, drawn parallel to and 4hours to the right of the alert line. It indicates the need for something to be done about poor progress of labour.

Cervical Dilation
This is plotted as O with an upward arrow on top. The 1st V.E is recorded and then the subsequent will be done every after 4hours and recorded.
On admission, cervical dilatation is recorded on the alert line at the place equal to her dilatation and time recorded at the space for time. If labour is progressing well, the plotting of cervical dilatation will remain plotted on the left of the alert line.

Descent of the Head
The cervix dilates as the foetal head descends into the mother’s pelvis. Descent is determined abdominally as the midwife places her hand over the foetal head. If all fingers cover the head, it is said to be 5/5 above the pelvic brim. Plot the descent of the head at every V.E conducted. It is plotted using “Δ” “O”

Uterine Contractions
The midwife is required to note:
The length
The strength
The frequency of uterine contractions
The strength of the contractions is assessed from the reactions of a woman and by laying your hand on the fundus and noting the degree of hardness of the contractions.

The following boxes show the type of contractions as follows.
1. Fill in one horizontal square for each contraction felt in a 10 – minute period
2. Use dots to fill in the squares for mild contractions lasting less than 20 seconds.
3. Use diagonal lines to fill in the squares for moderate contractions lasting 20 to 40 seconds.
4. Use solid color to fill in the squares for strong contractions lasting longer than 40 seconds
In the latent phase, contractions should be 1 or more in 10 minutes, each lasting 20 seconds or more.
In the active phase, contractions should be 2 or more in 10 minutes, each lasting 20 seconds or more.

FETAL WELLBEING
Foetal Heart Rate
Auscultate and listen to the foetal heart rate. It is a safe and reliable way of knowing that the foetus is well. This is done using a Pinards stethoscope or Doppler Ultra Sound apparatus.
Note the following:

Rate
1. Count the fetal heart rate in a full complete minute.
2. It should be within the normal range 120-160beats/min
3. Below 120beats may indicate bradycardia and above 160beats may indicate tachycardia, both extremes would indicate fetal distress.

Rhythm
The normal foetal heart has a coupled beat which remains steady.
The fetal heart rate is recorded on top of the graphs and is plotted every 30minutes (1/2hourly)

LIQUOR AND MEMBRANES
The condition of liquor gives more information to the midwife about the foetal condition especially after they have ruptured.
Normal liquor is clear.
At each V.E, it is important to note the state of the membranes or liquor and plot on the partograph as follows:
C- Clear liquor
B- Blood-stained liquor
M - Meconium stained liquor (fresh/old)
A - Absent liquor
I - Intact membranes
Dark green meconium may indicate foetal distress especially in non-breech presentation.
Absent may indicate ruptured membrane or the baby is post mature and hence reduced liquor volume.
If the above are noted listen to the foetal heart every 15minutes (1/4hourly)

MOULDING OF THE FETAL SKULL BONES
Moulding allows for reduction of the foetal head diameters and easy passage in the pelvic canal.
The recording is as earlier discussed:
0 No moulding
+ Bones in apposition
++ Bones overlapping but reducible on finger pressure
+++ Excessive moulding
In case of excessive moulding, the mother should be referred to the next level of health service delivery.

MATERNAL WELLBEING
All the recordings for the mother’s condition are entered at the bottom of the partograph
Vital Signs
Pulse - recorded every 30minutes, mark with a dot.
Blood Pressure- recorded every 2-4 hours, it is marked with fused arrows.
Temperature- every 2hours

Urinalysis
Each time the woman passes urine or micturites, measure the amount and test for glucose, proteins and acetone.

Drugs
Record all drugs given to the mother during labour in the space provided on the partograph

Fluids
Oral fluids or IV fluids should be recorded in the column provided.

INTERPRETATION OF THE RESULTS
1. The recording of the partograph should be done correctly and adequately in order to have a precise interpretation.
2. The recordings should be clear enough for everyone to read and interpret.
3. The symbols used should be familiar to everyone for easy interpretation.

27/01/2026

FETAL STATION 🩺

Fetal station describes how low the baby’s head is in the pelvis during labor.

📍 Key points:
• Measured from -5 to +5
• 0 station = baby’s head is engaged in the pelvis
• Negative numbers mean baby is still high
• Positive numbers mean baby is moving down for birth

It helps doctors track labor progress and know when birth is near.

.Nusia

22/01/2026

Amniotic Fluid

Amniotic fluid is the clear, pale-yellow fluid that surrounds and protects the fetus inside the amniotic sac during pregnancy.

Origin

• Early pregnancy: Formed mainly from
maternal plasma

• After mid-pregnancy: Mostly from fetal urine

• Also contributed by fetal lungs and membranes

Normal Volume

• 12 weeks: ~50 mL

• 20 weeks: ~350 mL

• 34–36 weeks (peak): ~800–1000 mL

• At term: ~500–600 mL

Functions

• Cushions fetus from trauma

• Allows free fetal movements (muscle &
bone development)

• Maintains constant temperature

• Prevents adhesion of fetus to membranes

• Helps in lung development (fetal breathing
movements)

• Acts as a barrier against infection

• Facilitates normal labor

Composition

• Water (≈98%)

• Electrolytes

• Proteins

• Glucose

• Lipids

• Urea, creatinine

• Fetal cells

• Hormones and enzymes

Amniotic Fluid Index (AFI)
Measured by ultrasound:

• Normal: 8–18 cm

• Oligohydramnios: 24 cm

Clinical Conditions

• Oligohydramnios:
Causes – fetal renal anomaly, placental insufficiency, post-term pregnancy

• Polyhydramnios:
Causes – diabetes, fetal GI obstruction, multiple pregnancy

Clinical Importance

• Assesses fetal well-being

• Used in amniocentesis for genetic testing

• Abnormal volume indicates fetal or maternal pathology

20/01/2026

MECHANISM OF NORMAL LABOUR

Mechanism of labour are the collective series of movements which the foetus has to undergo in order to pass through the birth canal.

1. ENGAGEMENT
This is a medical term often referred to as “baby dropping.” This means that the foetal head have settled into the pelvis prior to labor. If this is your first pregnancy( primigravida), engagement will usually occur about two or three weeks prior to the onset of labor. While in multigravida engagement takes place in labor.

2. DESCENT:
This is when your baby's head moves down (descends) further through your pelvis. Most often, descent occurs during labor, either as the cervix dilates or after you begin pushing.

3. FLEXION:
The uterine contractions will help the baby to descend and flex to present with the smallest diameters. So as the vertex descends into the maternal pelvis, it will encounter resistance from the maternal pelvic floor muscles. This will cause the flexion of the foetal head onto the thorax.

4. INTERNAL ROTATION OF THE HEAD:
As the presenting part meets the resistance of the pelvic floor muscle, it will rotate forward to lie under the SYMPHYSIS P***S. This is the turning forward of the fetal head to face the back of the mother as it reaches pelvic floor muscles. This causes a twist in the neck of the foetus.

5. CROWNING
As the presenting part distend the perineum,it will no longer descend back. This is when the baby's head start to be seen or emerge bit by bit during each contraction.

6. EXTENSION OF THE HEAD
This is the movement by which flexion is undone. Here, the face and chin passes over the thined out perineum and sweeps the perineum and the baby will give you a smile"hello!"

7. RESTITUTION
is the turning of the head to undo the twist in the neck that resulted from internal rotation remember...

8. Internal rotation of the shoulder and external rotation of the head:
Happens at the same time and in the same direction. The shoulder will enter the pelvic brim in the left oblique direction while the head will also follow in that same direction.
The anterior shoulders meets the pelvic floor muscles first and will rotate forward to lie under the symphysis p***s.

9. BIRTH OF THE SHOULDERS
The Anterior shoulder will escape under the p***c arch and be born by downward traction while the posterior shoulder will sweep the perineum and be born by upward traction.

10. LATERAL FLEXION:
The rest of the body is then expelled simultaneously over the mother's abdomen by lateral flexion.

20/01/2026

WHAT IS CERVICAL CERCLAGE.

Cervical cerclage is a surgical procedure where a strong stitch is placed in the cervix to hold it closed during pregnancy, preventing it from opening too early (cervical insufficiency) and causing preterm birth or late misc@rri@ge.

REASONS FOR CERVICAL CERCLAGE.

🔴 Cervical weakness (insufficiency): The cervix isn't strong enough to stay closed as the pregnancy grows.

🔴 History: Previous preterm deliveries or second-trimester miscarriages.

🔴 Ultrasound findings: Shortening or opening of the cervix before 24 weeks.

WHAT ARE THE RISKS OF CERCLAGE?

✅Possible risks could include:
✅Premature contractions.
✅Cervical dystocia (inability of the cervix to dilate normally in the course of labor)
✅Rupture of membranes.
✅Cervical infection.
✅Cervical laceration if labor happens before the cerclage is removed.
✅Some risks associated with general anesthesia include vomiting and nausea.

.Nusia

20/01/2026

The Menstrual Cycle

Monthly Hormonal Process in Women
The menstrual cycle is a natural, monthly hormonal process in a woman’s body that prepares it for pregnancy. It typically lasts 28 days, but a range of 21–35 days is also considered normal.
Phases of the Menstrual Cycle:

🔹 1. Menstrual Phase
The inner lining of the uterus (endometrium) sheds with bleeding
Lasts 3–7 days
Bleeding, cramps, and fatigue may occur

🔹 2. Follicular Phase
The brain releases FSH (Follicle-Stimulating Hormone)
Eggs begin to develop in the ovaries
Estrogen levels increase

🔹 3. Ovulation
One egg is released from the o***y
Most fertile time for pregnancy
Usually occurs around day 14 of the cycle

🔹 4. Luteal Phase
Progesterone levels increase
The uterus prepares for pregnancy
If pregnancy does not occur, hormone levels fall and menstruation begins
Important Points:

🩺 A regular cycle is a sign of good hormonal health
⚠️ Irregular cycles, severe pain, or heavy bleeding → consult a doctor

.Nusia

DR. AKOON BOL

14/07/2026

10/02/2026

03/02/2026

31/01/2026

29/01/2026

27/01/2026

22/01/2026

20/01/2026

20/01/2026

20/01/2026

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