High YIELD ob Flashcards by Sheila Sarmiento

HTN after 20 wks

Gestational Hypertension

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Evidence of Hypertension of pregnancy
HTN before 20 weeks

Chronic Hypertension

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HTN after 20 wks and proteinuria (300mg/24h)
end organ dysfunction

Preeclampsia

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fetal malposition
0-37 weeka

No intervention

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37+ weeks
Fetal Malposition

Extrernal Cephalic Version

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37+ weeks
Fetal Malposition

Extrernal Cephalic Version

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Fetal Malposition
Active Labor at any time

C-section

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37+ weeks with failed ECV, active labor or any contrindication to vaginal delivery

C-section

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Contraindications for external Cephalic version

Placenta previa or abruption
Multiple gestation
Ruptured Membranes

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Before 37 weeks

Preterm

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before the onset of contractions

Premature

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<34 wks, mgt?

Corticosteroids

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<32 wks , PPROM, mgt?

Magnesium Sulfate (neuroprotective)

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> 34 wks, PPROM, mgt?

Delivery

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Multiple “grouped” ulcers, eythematous base

Herpes Simplex Virus

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Severe painful ulcers with exudate + friable base
Painful inguinal lymphadenopathy with pus leakage

Chancroid (Haemophilus ducreyi)

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Single painless chancre

Priary Syphilis (Treponema Pallidum)

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Multiple painless ulcers
No lymphadenopathy

Granuloma Inguinale (Kleibsiella Granulomatis)

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small, shallow, painless ulcers
Large, painful, inguinal ympahdenpathy

LLymphogranuloma Venereum

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First growth spurt for girls

Bud development
(8-13 years)
areolar growth

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White thick, cottage cheese appearance
ph : Normal <4.5
Vaginal inflammation
Treatment : Oral Fluconazole (topical Miconazole if pregnant)

Candidiasis

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Off-white fishy odor
ph : Normal >4.5
No Vaginal inflammation
Treatment : Metronidazole for patient only (Clindamycin)

Bacterial vaginosis

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Greenish, frothy discharge
Red spots on cervic (strawberry cervix)
vaginal inflammation
Metronidazole for patient and partner

Trichomonas vaginalis

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What is the normal Ranges for AFI

5-24 cm
deepest pocket 2-8 cm

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Amniotic fluid index (AFI) 24 cm or Single deepest pocket 8+ cm enlarged uterus inability to swallow (esophageal atresia, eA + TEF, duodenal atresia) diabetes, multiple gestation, anencephaly Compications: PPROM, umbilical cord prolapse, Fetal Malpositionl

Polyhydramnios

AFI < 5cm or Single deepest pocket < 2 cm Uterus is less than estiamted dates Potter's sequene (Pulmonnary hypoplasia, flattened face, dysmorphic limbs) Complications: Meconium aspiration, Umbilical cord compression

Oligohydramnios

Unilateral breast erythema Skin dimpling warmth

Inflammatory Breast carcinoma

PCOS with post menopausal bleeding for 1 month

Endometrial carcinoma

patient with fever, RUQ pain, rebound and guarding

Appendicitis

beefy protrusion of tissue at the urethral meatus

Urethral Prolapse treat with topical estrogen

Purulent vaginal discharge Mass at the Vaginal introitus

Vaginal Foreign body

Non-tender abdominal bulge in postpartum patient with no facial defect on palpation

Rectus Abdominis diastasis

Post menopausal bleeding, thickened endometrial stripe ovarian mass

Granulosa Cell tumor

Amenorrhea and cyclic abdominal pain each month

Imperforate Hyrmen

History of multiple miscarriages, positive VDRL and elevated PTT

Antiphospholipid Antibody Syndrome

Pregnant woman with fever, dysuria, flank pain

Pyelonephritis

Pregnant woman at 0 weeks with uterine size larger than estimate dats severe nausea and vomiting BP 155/95 markedly elevated B-hG

Complete Hydatidiform Mole

Pregnant woman with severe nausea, vomiting, orthostatic hypotension, ketones in urine

Hyperemesis gravidarum

Pregnant woman with anemia, thrombocytopenia, LFTS elevated

HELLP Syndrome

Pregnant woman with severe RUQ pain, thrombocytopenia, profound hypoglycemia, elevated LFTS and DIC

Acute Fatty Liver of pregnancy

Erythematous unilateral nipple rash, itchy and refractory to steroids

Paget Disease of the breast

Pregnant patient with fever, uterine tenderness, vaginal discharge, fetal tachycardia

Chorioamnionitis

Amenorrhea, anosmia, cleft palate

Kallmann syndrome

What is the management of Lichen Planus

Reassurance + steroid

What is the management of Vulvovaginitis in Prepubertal Girls

Reassurance , Steroid

A girl deveop labial fusio past h/o of vulvovaginitis which was treated successfully. No voiding difficulties. Most approp advice?

Reassurance

Post menopausal female comes to you with enterococele prolapse and stress incotinence What is the management

Pessary

A woman taking OCP containing 30mg estrogen now comes to you with hypertension What is the next step?

POP

Mentally retarted girl complaining of menorrhagia Best tx?

Mirena Levonorgestrel-releasing intrauterine system

Young lady came for contraception advice she feels headache BP 130/90 What to prescribe?

POP

Girl came for repeat prescription for OCP Some headache with visual disturbance Best advice?

OCP is contraindicated

Girl comes with a period pain Best treatment?

Mefenamic Acid

Newly delivered pregnant woman and is on breastfeeding Wants to conceive as soon as possible again What contraception you should give?

Progesterone Pill only

After delivery, breast feeding whicn contraception?

Levonorgestrel

How does the Microgynon works?

In the hypothalamus

A patient comes in asking for OCPS She also reports that she has been experiencing migraine What do you do?

Start Progesterone

Female using 30 mg ocp Presents with continuing painful periods Want to conceive after 12 to 12 months What to advice?

use 50mg ocp

Woman with 3 kids, has otosclerosis with hearing aid Which contraceptive is best for her?

IUCD

Lady with obesity, hirsutism and PCO asking for contraception

COCP

A lady comes to your practice concern about her OCP compliance ont he 10th day She missed her pill on the 7th and 8th day She has unprotected intercourse on the 6th and 7th day What is your management?

Give emergency contracptionw ith levonogestrel twice dose 12 hrs apart

What is the gold standard for the abnormal uterine bleeding?

Hysteroscopy and D and C

Young girl with h/o Epilepsy well controlled with Phenytoin wants to have an OCP. What will be your advice?

IUCD

Most important contraindication for prescription of OC pill in this patient?

Breast Cancer

A 20 yo woman came to you and ask for contraception advice. Mother and sister has DVT episode. What is the next best step?

Do thrombophilia screening

A menopausal woman came with complains of hot flushes and vaginal dryness Vaginal exam shows atopic vagnitis. She had hysterectomy 10 years ago and she said she also has VT What is the best treatment?

Low dose transdermal oestrogen

A 10 wk pregnant patient comes to you for her first antenatal visit You see the strings of the IUCD. What is your next step?

Remove the IUCD now

A woman taking OCP containing 30 mg esterogen now comes to you with hypertension What is the next step?

POP

Young lady came for contraception advice. She feels headache and her BP is 130/90. What to prescribe?

POP

Ladi with migraine, pins and needle sensation, shes asking for cotnraception. What to give?

POP

Mentally retarded girl complaining of menorrhagia, looking for best contraception.

COCP

45 yo female with menorrhagia and consultation is due in a few weeks, what can you give for the meantime?

NET

Came for contraception, mother and sister has DVT and found out to have factor V defect What will be approp for her?

Progestogen only Mirena IUD

Young lady comes to you on the 10th day and she missed her pill on the fay 6 , 7 and day 8 she had intercourse She took her first pill from the new pack today What will you advice her?

Emergency Contraception

Which would be the best option for OCP for a smoker female?

Norethisterone

HcG <2000 IU/L

Repeat tVS / HCg in 48-72 hrs

Hcg > 2000 IU/L abd TVS with no IUP Complex adnexal mass and/or free fluid

High probability of ectopic pregnancy

hcg > 2000 IU/L and TVS with no IUP and no abnormal findings

Repeat TVS /HCG in 48-72 hrs

Vaginal bleeding prior to 20 weeks gestation

Threatened Abortion

Passage of POC of a non-viable IUP or expected to occur imminently

Inevitable

Retention of POC od a non-viable IUP

Incomplete

Ultrasound scans diagnosis of a non-viable IUP in the absence of vaginal bleeding

Missed

Misscarriage complicated by infection

Septic

Three or more consecutive miscarriages

Recurrent

Full epulsion of POC of an IUP

Complete

HSIL

Refer for Colposcopy

Negative cytology

Repeat HPV test in 12 months

Possible lwo grade intraepithelial lesion and definite LSIL

Repeat HPV test in 12 months

Unsatisfactory cytology result

Repeat test in 6-12 weeks

Pap test negative smear - no Endocervical cells

Repeat in 2 years

Pap Test negative Smear - inflammatory Cells

Repeat test in 2 years

Unsatisfactory smear

Repeat smear in 6-12 wks

LSIL and definitive LSIL

Repeat Pap test at 12 months If the woman is 30+ years and has no negative cytology in previous 2-3 years, refer to Colposcopy or Repeat the test in 6 months

Possible HSIL and definite HSIL

Refer for Colposcopy

Glandular abnormalities

Refer to gynecologist

Invasive Squamous cell carcinoma or Adenocarcinoma

Refer to a gynecologist

Inconclusive - raising possibility of high grade disease

Refer for colposcopy and possible biopsy

Post coital bleed

Atrophic vaginal

Postmenstrual Bleeding

Endocervical Ca until proven otherwise

Post menstrual bleeding bleeding within 1 year

Graaffian Follicles

53 yo bleeding Postmentrual symp

Atrophic Vaginitis

postmenstrual bleeding + growth

Cervical Cancer

Intermenstrual bleeding multiple sexual partners no vaccine

Carvical Ca

Dysmenorrhea 1st line treatment?

Mefenamic Acid

Heavy Menstrual bleeding 1st line?

Mefenamic acute flood - Tranexamic Acid

Young girl + OCP user + bleeding

Cervical Ectropion

Postcoital bleeding 55 years

Cervical CA or Atrophic Vagintis

Postcoital bleeding 25 years

Polyp or cervical ca or Ectopian

Abnormal uterine bleeding

Fibroids

50 years recently menopause 8 months new onset of bleeding

Anovulatory cycle (Graddian follicle)

60 years old female with post menopausal bleeding

Endometrial CA

53 years postcoital bleeding [ain during coitus

Atrophic Vaginitis (lack of estrogen)

58 years post coital bleeding

Cervical cancer

Mass seen in the vagina

Cervical cancer

Menopause within a year

Graaffian F

Any age group universal cancer

Ca of the cervix

clear mass

cancer mostly

bleed on touch

Ca polyp

What are teh premenstrual treatment

Hormone therapy Vaginal Estrogen Antidepressants Gabapentin

T score of -2.5 or lower indicates that you have

Osteoporosis

T scoring of -1.5 to -2.5

Osteopenia tx: Calcium and Vitamin D

T scoring of >2.6

Osteoporosis tx: Alendronate / Zollindronic Acid IV more preferable

Osteoporosis is known + low trauma fracture

DEXA first

T score of -2.5, Osteoporosis tx?

Alendronate

Osteoporosis + fracture

DEXA

Osteoporosis + PUD

Zolindronic Acid

Osteoporosis + Breast Ca

Tamoxifen / Raloxifen

Severe osteoporosis + HRT for 6 years what to give?

Alendronate

Drug of Choice for hypertension with pregnancy

Methyldopa

What must be avoided in pregnancy

ACEI

What are the other antibiotics that should be avoided in pregnancy?

SAFE Sulfonamides Aminoglycosides Fluoroquinolones Erythromycin Ribavirin Grieofulvin Chloramphenicol

new onset of grand mal seizures in women with preeclampsia

Eclampsia

What are the signs of preeclampsoa

Persistent headache visual disturbances epigastric pain or RUQ pain Vaginal bleeding due to Hypertension hyperreflexia

The only cure for preeclampsia is

Delivery of the fetus

If the patient is close to term in peeclampsia What to do?

Induce Delivery

If the patient is far from termin preeclampsia what to do?

Expectant Management

What is the first step to control BP in the severe preeclampsia

Labetalol and or hydralazine the goal is <160/110 with DBP of 90-100 to maintain the fetal blood flow

What is the second step of management in severe preeclampsia

Prevent seizures with continuous magnesium sulfate continue sezure prophylaxis for 24 hours postpartum

What is the third step in severe pre-eclampsia

Deliver by induction or C section

used to accelerate the fetal lung maturity

Dexamethasone given at 24th to 34th week

If there is seizure for the first time what is the next step?

Glucose Electrolytes

If there is seizure for 4 years and recurrent what is the next step?

Glucose

What is the first step in Eclampsia?

ABCs with supplemental O2

What is the second step of management in Eclampsia

Seizure control / prophylaxis with magnesium if seizures recur then give IV diazepam

What is the third step of management in Eclampsia?

Delivery

What is the first sign of toxicity of magnesium sulfate

loss of deep tendon reflexes

What is the serious sign of magnesium sulfate toxicity?

Repiratory Depression Comma

What is the treatment for the toxicity of magnesium sulfate

IV calcium gluconate

Pain + amenorrhea + vaginal bleeding

Ectopic Pregnancy

What is the most common site of ectopic pregnancy

Ampulla of the fallopian tube

What is the recurrence rate for Ectopic pregnancy?

10-15%

What are the predisposing factors for the Ectopic Pregnancy?

Scarring to the Fallopian tubes

What is the most common cause of Ectopic Pregnancy?

History of PID

Woman of reproductive age presenting with abdominal pain and vaginal bleeding dx?

Ruptured Ectopic Pregnancy

What are the steps of management for Ruptured Ectopic Pregnancy?

First step: Pregnancy Test if (-) : NO PREGNANCY if (+) : transvaginal Ultrasound If you find a sac in the uterus: Normal Pregnancy Empty uterus: do Serial HcG Doubling : Normal Pregnancy No doubling: Ectopic

What is the medical treatment for ectopic pregnancy?

Methotrexate

What is the endoscopic management for the unruptured ectopic pregnancy and stable patient?

laparoscopy

How to diagnose unruptured Ectopic pregnancy?

B Hcg titer <1,500 mIU No intrauterone pregnancy is seen in vaginal sonogram

Ectopic pregnancy is always seen in 1st trimester

true

Defined as any bleeding that occurs after 20 weeks

Antepartum hemorrhage

The most common caused of Antepartum Hemorrhage are

Placental abruption and placenta previa

Separation of the placenta from the inner wall of the uterus before the baby is delivered

Abruptio Placenta

Placenta is implanted in the lower part of the uterus obstructing vaginal birth

Placenta Previa

placenta covers the cervical os

Total

placenta extends to the margin of the os

Marginal

placenta is in close proximity to the os

Low-lying

What is the most common risk factors for placenta previa

Prior C section others are: Grand multiparity Multiple Gestation prior placenta previa

What to give if the mother is Rh D negative?

Anti-D prophylaxis

What is the most common cause of Placenta Abruption ?

Hypertension

What is the very impt cause of Placental abruption?

Cocaine

painful dark vaginal abdominal painn + uterine contraction on exam : Uterine tenderness Uterine hypertonicity fetal Distress

Placental Abruption

How to manage patient with Placental abruptio?

Stabilize patients hospitalize start IV and fetal monitoring

fetal vessels crossing the internal Os

vasa previa

What is the main management of Vasa previa

What is the most common risk factor for placental abruption

Hypertension

What is the most common risk factor for placenta previa

Previous CS

Bleeding with placental abruption

Painful

bleeding with placenta previa

painless

Most impt sign with the placental abruption

Uterine tenderness

Main route of delivery with both of them

Vaginal

Mgt if there if fetal distressed?

Main inv with placenta previa

Main inv with placental separation

The drug that causes placental infarction

Cocaine

What is the main complication with placental separation

DIC

Main risk factor for stroke

Hypertension

Main risk factor for MI

Hyperlipidemia

Main risk factor for placental separation

Hypertension

Main factor causing damage of kidney in diabetic patients

Hypertension

What is the most common cause of abdominal pain with pregnancy in 2nd trimester usually site is the Right side jabbing sensation or sharp stabbing pain felt when a pregnant woman suddenly changes position

Round Ligament Pain

What is the differential diagnosis of Round ligament pain

Appendicitis

What is the tx for the round ligament pain?

Analgesic and Rest

What is the most common cause of uterine prolapse

Premature ruprute of the membranes

What are the steps of management in the Round ligament pain

1st step: Assess the pulsation of the umbilical cord to see if the fetus is still alive or not 2nd steo: Put patient in the knee - chest position (trendelenburg) 3rd step; Push the presenting part back ward to decrease the pressure 4th step: CS

jaundice and itching at the third trimester bilirubin and ALT elevated

Cholestasis of Pregnancy

What are the risk for cholestasis of pregnancy

fetal distress and mortality

What is the inv for Cholestasis of pregnancy

CTG

What is the treatment for the Cholestasis of pregnancy?

Ursodeoxycholic acid

What is the complication of Pyenephritis with pregancy

Preterm delivery

What is the tx for the Pyelonephritis in pregnancy

Hospitalization IV Ceftriaxone and Gentamycin

10 wks gestation with uterine bleeding, pelvic pressure and multiple episodes of non-bloody and non-bilious emesis bleeding is like a prune juice uterus is larger than gestational age

Gestattional Trophoblastic Disease

Snow storm cluster of grapes honey comb

Gestational trophoblastic inv: B-hcg chest xray if patient presents with pulmonary symptoms

69 XXX or XXY missed abortion

Partial Mole

46 XX or XY molar gestation

Complete mole

defined as a birth weight > 90 th percentile

fetal macrosomia

Most common cause of fetal macrosomia

Defined as the AFI > 20 on ultrasound

Polyhydramnios

Duodenal atresia tracheoesophageal distula Potter Syndrome

Polyhydramnios

AFI < 5 cm on ultrasound

Oligohydramnios

what is the most common cause of polyhydramnios

Renal Agenesis

What is the risk factor for Shoulder dystocia

Obesity and Diabetes

Prolonged second stage of labor Recoil of the perineum or turtle sign

Shoulder Dystocia

What are the treatment for Shoulder Dystocia

Help reposition Episiotomy Leg elevated (first step ( McRobert's MAneuver) Pressure suprapubic - s econd most important Reach for the fetal arm

What are the complications of shoulder dystocia

Clavicle Fracture Brachial plexus Injury

Most important risk factor for the shoulder dystocia

Diabetes Mellitus

What is the first step mgt in Shoulder dystocia

Elevation of the patient's legs second step: suprapubic pressure

What is the most common nerve injury with the shoulder dystocia

Brachial Plexus

What are the signs of clavicle fracture

fullness, crepitus or deformity

What are the roots that are affected in the Erb's palsy?

C5 and C6

internally rotated arm, adduction (waiter tip) hand it is associated with the diaphragmatic paralysis resolve in 3 months

Erbs palsy

What are the roots affected in Klumps palsy Associated with the horner Syndrome

C7, C8 and T1

rupture of membranes occuring at <37 wks gestation

PPROM

Defined as rupture > 18 hours prior to the delivery

Prolonged ROM

sudden gush of clear or blood tinged amniotic fluid

Rupture of membrane

What are the steps in diagnosing the Rupture of membranes

First step: Sterile Speculum ecam - pooling of amniotic fluid in the vagina Nitrazine paper test is - when the paper turns blue - indicated that the paper is alkaline of ph amniotic fluid Second step: ultrasound

What is the treatment for the Rupture of membranes?

Induce Labor

Rupture of membranes mgt if it is >34-36 wks

Labor induction

Rupture of membranes mgt if <25-32 wks gestation

Expectant management with bed rest try to delay as long as possible so that the baby become more mature a high vaginal swab is advisable

defined as onset of labor between 20 and 37 weeks

Preterm labor

What is the inv to confirm the preterm labor

Fetal fibronectin

1st tri pregnant woman cervical screening test + for HPV 16 and 18 HSCIL

Colposcopy oc cervix ith biopsy

Most common symptom of endometriosis

Dysmenorrhea

If ovarian cyst is less than 5 cm in size

Repear Ultrasound in 4 months

lower abdominal pain, significant vaginal bleeding and amenorrhea

Ectopic pregnancy

Has intrauterine gestational sac (altho empty) abd b fkuid in the Pouch of Douglas no tenderness and cervical os is closed

Missed abortion

If intrauterine pregnancy tissue is completely expelled

Complete miscarriage

Intrauterine pregnancy tissue is partially expelled

Incomplete miscarriage

three or more consecutive miscarriages

Recurrent Miscarriage

miscarriages complicated by infection

Septoc

ultrasound scans diagnosis of a non-viable IUP in the absence of vaginal bleeding

Missed

Some retention of POC (products of conception, IVP , intrauterine pregnancy) of a nonviable IUP

Incomplete

Passage of POC of a nonviable IUP occuring or expected to occur imminetly

Inevitablee

Vaginal bleeding prior to 20 wks gestation

Threatened

headache that occurs one day before the onset of menses pain starts in the occipital area and spreads towards the left frontal region aggravated by walking irritable and sensitive to light

Menstrual headache

What is the most comon presentation of the ovarin cancer?

Abdominal mass and ascites

What is the screening marker for the ovarian cancer

CA 125 and transvaginal ultrasound

What is the average age group diagnosed with ovarian cancer

50-64

Carries the lowest risk in developing the ovarian cancer

Oral contraceptive pill

HPV can call all these subtypes of cancers except:

Cancer of cervic cancer of oropharyngeal cavity Squamous cell carcinima of anus, penis and agina Cancer of the uterus except: ESOPHAGEAL cancer

post menopausal woman presented with mild vaginal bleeding for the last 12 hrs after the sexual acitivity

Atrophic Vagintis

What are the risk factors for urinary incontinence

Obesity Prenatal urinary incontinence Constipation Instrumental delivery Third and fourth degree tears Baby with a right birth weight of more than 4.0 kg

40 yo with hx of postcoital bleeding periods were normal and regular for the last 12 months now she is complaining of intermenstrual bleeding for a year she has multiple sexual partners What to do next?

Cervical Screening test as well as liquid base cytology

Asking for contraception advice she has a family history of DVT and thrombophilia Most appropriate contraception?

Levonorgestrel intrauterine device

A petient had undergone total abdominal hysterectomy complaint of clear fluid discharge from the vagina Discharge is continuous in nature but without any odor or itching. What is the most likely cause of her symptoms?

Reactionary fluid from vaginal wall

A middle age woman presented with peristsent lower back pai and sensation of heaviness in the vagina A bulge protruding out of the vagina is noted on the examination What is the responsible for this?

Uterosacral ligament - patient developed uterine prolapse - weakening of the uterosacral ligament

1st line contraceptive choice for women with epilepsy using enzyme inducing antiepileptic drug

Levonorgestrel-releasing intrauterine contraceptive device

OCPS increase the incidence of

Cervical Cancer

What is the investigation of choice for the earlier diagnosis of endometriosis

Diagnostic laparoscopy with histopathology

Breast tender, swollen and painful not sexuallya ctive and not planning to have any relationship in the future mgt?

Primrose oil - mastalgia

premenstrual women simple ovarian cyst <5cm

Do not require follow up Reassurance no further action required

premenstrual women simple ovarian cyst 5-7cm

Repeat Ultrasound

premenstrual women simple ovarian cyst >7cm

Refer to gynecologist

Postmenopausal women simple ovarian cyst <5cm and low risk of malignancy

Manafe conservatively it will resolve in 3 months

Postmenopausal women simple ovarian cyst 2-5 cm

should be rescanned 3-4 months

This contraception is contraindicated in pregnancy, breast cancer and undiagnosed vaginal bleeding

Progestgen only

contraceptive use with a past medical history in hypertension

Progestogen only pills

Which outcome has the most sutiable outcome to the treatment of infertility?

Stein-Leventhal Syndrome or PCOS

Postmenopausal woman with frequent hot flushes had a hx of oestrogen dependent breast cancer ten years ago What is the mgt?

Paroxetine

mestrual irregularities and hirsutism

PCOS

Woman inability to conceive last 12 months Pelvic USG shows 3-4 follicles in both ovaries. Blood test low estrogen and elevated FSH and LC Keen to get pregnant Mgt?

In vitro fertilization

Danazol for endometrisos treatment Side effects?

Lighter or absent menstruation, since danazol causes endometrial atrophy

Best emergency contraception

Copper intrauterine contraceptive device next is Ulipristal Acetate and Levonorgestrel

Invasive squalous cell carcinoma was diagnosed What is the nest step?

refer to a gynecologist at tertiart hospital

Nulliparous woman presents onset of painful menstrual irregular bleeding bleeding isheavy and erratic with 25-37 day cycle. She is sexually active and no history of hyspareunia or postcoital bleeding. The couple doesnt want to have children in the future Mgt?

Endometrial Ablation

Risk factor for the development of ovarian cancer

Increased body mass index

Which of the ff is the advantage of using progestogen implant over the contraceptive options?

It provides contraception for three years and is easily reversible

HPV non 16 and 18 and Low grade Intraepithelial lesion o reflex liquid basec cytology

Repeast Cervical screening test in 12 months

Gray vachinal discharge with burning and itching

Gardenerella vaginali

History of vaginal bleeding after sexial interourse She has a mucupurlent cervical discharge What to do

Vaginal swab for chlamydia and gonorrhea

64 yo woman with painless vaginal bleeding lasted for 2 months TV shows endometrial thickness of 6mm Associated with increased risk of endometrial cancer?

PCOS associated with Chronic Anovulation

Not correct regarding the peri-menopause stage

Decrease in FSH

She never had a sexual activity with a male She is a lesbian and has a gf she prefers a lesbian friendly health care provider What is the approp advice?

Refer to a lesbian friendly clinic in the area

diffuse pelvic pain and vaginal bleeding painw ith defecation, dyspareunia and dysmenorrhea dx?

Endometriosis

c/o urinary incontinence Suggestive of urge incontinence urinarylysis is negative mgt?

Instruct her to eliminate excess water and caffeine from her daily fluid intake

Gradual onset of bilateral pain associated with fever, vaginal discharge and mild dysuria Adnexal and cervical motion tenderness Cause of the pain?

PID

free fluid within the abdominal cavity abdominal pain and vaginal bleeding

Ruptured Ectopic pregnancy

amenorrhea came to hospital with massive per vaginal bleeding

Urine Pregnancy test

PMS symptoms - depression and emotional symptoms Tx?

Fluoxetine

Treatment for hirsutism and facial acne

OCPS

Pap smaer: test result: HGSIL Coposcopy confirms the presence of a cervical lesion consistent with cervical dysplasia (CIN III) Which of the ff type of HPV confirms this type of lesion

HPV 16

1 hr acute onset of progressively worsening pain in her RLQ

Immediate laparoscopic surgery

Increasing hair growth in her face, chest and abdomen coarse, dark hair on her face and abdomen enlarged clitoris 7cm left adnexal mass What type of ovarian tumor?

Sertoli Leydig Cell

Occasional abdominal cramping associated with bleeding without passage of fetal products closed cervical os dx?

Threatened abortion

9 cm right ovarian mass Shows the evidence of glial tissue and immature cerebellar and cortical tissue dx?

Immature teratoma

KOH prep - fishy odor tx?

Metronidazole

Small amount of urine when sneezing

Stress incontinence

She has cyclic pain during premenstrual period and during her menses inv?

MRI

Biopsies show chronic cervicitis but no evidence of dysplasia mgt?

Conization of the cervix

Post op total vaginal hysterectomy 2 wks ago also had the Burch procedure for uterine prolapse and stres urinary incontinence she complains a constant loss of urine throughout a day denies any urgency or dysuria dx?

Vesicovaginal Fistula

Postmenopausal had cancer 5 years ago complains of mood swings, disturbed sleep and hot flushes mgt?

Paroxetine

highly suggestive of pCOS

Elevared LH

Least likely site for Endometriosis

Cervix

Planning to conceive. Labtest results are LH low, FSH low, TSH Low and Prolactin is high mgt?

Bromocriptine

Pre-menstrual period has bloating, headached, reduced libido and reduced concentration and anger management symptoms get worse 1 week before the menses Mgt

Sertraline

50yo with history of hysterectomy and DVT with hot flushes mgt?

Osterogen Dermal Patch

history of smoking and asking for contraception

Progesterone only pills

Best option for the treatment of endometriosis

Danazol

Ovulatory dysfunctional uterine bleeding Mgt?

Tranexamic Acid

INCORRECT regarding menopause

Decresed FSH level

Fishy, offensive gray vaginal discharge Clue cells are present mgt?

Clindamycin - Bacterial Vaginosis

Asking for contraceptive advice She had hx of DVT and currently on treatment with anti-coagulants She is on combined oral Contraceptive Pill Mgt?

Progesterone only pill

purulent lochial dischage

Endometriosis

Best invt to establish ectopic pregnancy

Transvaginal Ultrasound

1st line of inv for Ectopic Pregnancy

B-Hcg

NOT A risk factor for cervical cancer

Alcohol

Absolutw contraindication to use the progestogen only pills

Rifampicin

Which is correct regarding continuous used of combined hormone replacement therapy

It increases the risk of breast cancer

Next choice of investigation to predict ovualtion

Serum progresterone

She has high grade abnormality on cervical screening test She has colposcopy and has higher abnormal cells in the cervical canal mgt?

Cone Biopsy

Gold standarc choice of investigation for the diagnosis of abnormal uterine bleeding

Hysteroscopy along with Dilatation and curettage

Vaginal itching and discharge Red vulva and whitish discharge tx?

Clotrimazole

Risk factpr for endometrial hyperplasia

Early menarche

Correct description of hysterosalpingogram

Unilateral hydrosalpinx with a normal uterine cavity

Most common type of cervical cancer in Australia

Squamous cell carcinoma

irregular bleeding for the past 5 months period were reguklar pap smear norma

Anovulatory cycles

episodes of painless vaginal bleeding What is the cause of teh postcoital bleeding

Cervical ectropion - Chlamydia cervicitis a cervical polyp or cervical carcinoma

Tx for severe mastalgia

Danazol

test to evaluate amenorrhea

LH and FSH levels

Troublesome urinary leakage What is the first step of evaluation?

urinarlysis and culture

FSH and LH high not started her period, no brest budding, no pubic hair has cervix and uterus What is the cause of her delayed puberty and sexual infantilism ?

Gonadal Dysgenesis

Signet cells

Krukenberg tumor

Normal breast and pubic hair development Uterus and Vagina are absent dx?

Mullerian Agenesis

One sided pain that is diffuse and dull, occasionally sharp menses are normal Smooth mobile andexal mass on the Right side What is the cause of the pain?

Ovarian Cyst

23F presented amenorrhea for 6 wks Which of the ff will make you decide to proceed for emergency intervention?

Shoulter tip pain

complainet of amenorrhea for one year duration what may be the cause of the amenorrhea?

Hormonal dysfunction

CIN2 mgt?

Colposcopy

Absoulute contraindication of COCPs

her premenstrual headaches

multiple fibroids, pakpabkle up to the umbilicus

GnRH analogues for 3 months followed by myomectomy

Treatment for the urge incontinence

bladder training

Vaginal discharge and gush of clear fluid rupture of membranes and cervix is closed most approp treatment?

Systemic Steroids

salpped cheek

Parvovirus B19

most frequently responsible for septic shock in Obstettric and gynecology

Escherichia coli

Whixh of the followig is correct regarding cesarian section delivery

Increased rick of adhesions

Uterine bleeding in the presence of closed cervix

Trhreatened abortion

Indicaated for the treatment of Chlamydia; urtehritis in pregnancy

Azithromycin 1 g single dose

DOC for the treatment of bacterial vaginosis in pregnant woman

Clindamycin

12wks gestation persistent nause and vomiting mgt

Pyridoxine - treatment for hyperemesis gravidarum

Recommended suppllement for pregnancy

Folic Acid 5mg daily 12 wks befoe conception 150 mg micrograms of Iodine

Planning to conceive in the next 3 months DM well controlled current HBA1c is 6% Supplement needed?

Folic Acid

Not a complication of obesity in pregnancy

ncreased risk of postpartum psychosis

NOT associated with Oligohydramnios

Gestational Diabetes

Not a contraindication to Tocolysis

Materanal Hypothyroidism

Not a risk factor for isolated spontaneous abortion

Retroverted Uterus

32 wks gestation Diagnosed with breech postion Not in labour and is still breech position in the pelvic examination appro step?

Pelvic ultrasoud

38 wks gestation with labor pains since 8 hrs ago Vaginal examinatio shows 7cm dilated and fully effaced On Amniotomy - greenish vaginal fluid 140 bpm with accelarations and variable deceleration beat to beat variability with good contractions Next step?

Fetal Scalp blood sampling

20 wks pregnant and have found to have thyrotoxicosis and mild enlargement of the thyroid gland inv?

Ultrasound thyroid gland

Which of the ff can reduce the risk of [pre-eclampsia during the pregnancy

Calcium 1000 mg daily

Most common feature of pre-eclampsia

Proteinuria

DOES NOT increase the risk of postnatal depression

Elective cesarian section

Most likely the cause of oligohydramnios in the second trimester of pregnancy

Renal Agenesis

best negative predictor of imminent birth within the next 7 days she is at 34wks of gestation

The absence of fetal fibronectin in cervical secretions

Woman who developed epilepsy and has been stable on Lamotrigine Planning to conceive and is concerned about the medications that can harm her baby Which of the ff measure would reduce the incidence of neural tube defects?

High dose of folic acid for one month befoe conception and during the first trimester

Which of the ff is correct regarding the shoulder dystocia

Erb is common fetal injury

32 female diagnosed with DVT of calf beins at the 20th week of pregnancy best mgt?

Therapeutic dose of low molecular weight heparin for 3 months

Which of the dd if present can lead to death during the pregnancy

Mitral Stenosis

Folic acid 0.4 mg is usually recommended one month before conception til 12 wks of gestation. A higher dose of folic acid 5mg daily is recommended in all of the ff situations except

Body mass index of 24

20f Asian with hx of Pulmonary hypertension. What would you advice?

Pregnancy is contraindicated in her condition

Most common method of termination of pregnancy before 20 wks in Australia

suction and curettage

30yo woman decides to conceive and is stable on lithium fir the severe relpasing bipolar disorder Lithim is continued after discussion witht he aptient Which one of the ff will be essential during pregnancy

High Resolution of ultrasound 18-20 wks of pregnancy

Hemolysis , relevated liver enzymes, and low platelet levels

HELLP Syndrome

Stool microscopy showed human roundworm infestation First line option for treatment

Pyrantel

Not elevated in the rhid trimester pf pregnancy

Serum free T4

Which od the ff vaccine is recommened to use during pregnancy

Influenza vaccine

Not a complication related to smoking during pregnancy

less likely to die of sudden infant death syndrome

Which of the ff condition would require intrapartum antibitic prophylaxis

A previous infatn with Grp B strep disease regardless of present culture

Which of the ff is a contraindication to pregnancy BMI 40 Absence of retinopaty Age of 38 Absence of nephropathy history of type 2 DM with HBA1c above 10

history of type 2 DM with HBA1c above 10

Indication to perform cervical cerclage at 14 wks of gestation

2 or more consecutive prior second trimester pregnancy losses

Aboriginal woman have a rubella IgM and IgG positive during routine antenatal screening What is the approp mgt?

Repeat Rubella serology

24f delivered a baby at 35wks has a Diagnosed with gestattional hypertension at 22 wks BP 170/100 Motivated to bresfeed her baby medication to treat her bp which s safe to both mother and the baby

Metoprolol

24 Aboriginal lady presents at antenatal clinic at 19 wks of gestation Best time for which of theff

Ultrasound

Ultrasound for identification of phyical abnormalities including neural tube defects is best performed at what age of gestation

18-20 wks of gestation

Maternal Serum screening for Down Syndrome is best performed at what age of gestation

15-17 wks of gestation

Amniocentesis is best perfomed during

between 16-18 wks of gestation

Chronic villus sampling is best perfoemd between this is accurate for diagnosis of chromosomal anomalies

10-12 wks of gestation

Rubella screen is best perfoem

before conception and not during pregnancy

Sudden onset of severe abdominal pain, vaginal bleeding and cesation of contractions after 28 hrs of active ushing at home Abdomen is distended Fetal heart sounds not audible

Uterine rupture

Vaginal bleeding at 16 wks of gestation RH negative and her baby is Rh positive Cervix is dilated and product of condeption are visible Pelvic usg - spontaneous abortion What will you do regarding anti-D administration?

Give anti-D now

At which weeks of gestation should the gestational diabetes status be checked

28 wks

20 wks pregnant woman has developed palpitatins, sweating of palms and increased nervousness What other investigations should be done with TSH

Free T4

Purulent lochia discharge noticed on vaginal examination 3 days after cesarean section

Gentamicin and clindamycin - postpartum endometritis

Nausea and vomiting during pregnancy and headache Past medical history of migraine Most approp management to prescribe for 1 wk

Codein and promethiazine - dx severe migraine

36 wks of pregnancy presents with BP 40/95, proteinuria, headache and mild upper abdominal pain Most approp management?

Immediate vaginal delivery - severe preeclampsia management

Right iliac fossa pain esp when she tried to stand up or cough had a history of appendectomy 12 yrs ago Mild tenderness in the Right iliac fossa no rebound tenderness and there is no guarding Diagnosis?

Round ligament pain

Young mothers have a higher risk of several pregnancy complications including which of the ff

Low birthweight infants

Complications of Warfarin use

Warfarin is contraindicated in the First trimester - it will cause fetal chondrodysplasia punctata if used in second or third trimester - fetal optic atrophy and mental retardation

involves the vaginal mucosa or perineal ski byt not the underlyig tissue what type of vaginal delivery tear?

First degree

it involves the underlying subcutaneous tissue byt not the rectal sphincter or the rectal mucosa

Second degree

The rectal sphincter is affected

third degree

extends up to the rectal mucosa

fourth degree

Biophysical profile revealed severe oligohydramnios Evaluation of the infant for the ff should be included

Renal Agenesis

It promotes lung maturity and decreases the risk of resp syndrome

Bethamethasone

Contraindication for tocolysis

Suspected placental abruption

Best management for Staph saprophyticus

Augmentin

Explusion of all fetal and placental tissue from the uterine cavity at 10 wks gestation

Complete abortion

Major predisposing factors in the developmentEctopic pregnancy

PID Any opetarive procedure on the fallopian tube may increase the risk - Tubal sterilization with laparoscopic fulguration

Used in prevention of recurrent eclamptic seizure

Magnesium Sulfate

Pregnant patient at 29 wks developed flu like symptoms - runny nose, mild headache and feels achy. She is at higher risk of giving birth to a newborn with ?

Wide Pulse Pressure (PDA due to Rubella)

11 wks gestation, uterus is palpable between the symphysis pubis and the umbilicus No fetal heart tones are audible mgt?

Shceule an ultrasounf as soon as possible to determine the gestational age and viability of the fetus

Prenatal CMV infections may produce which retinal disturbance

Chorioretinitis

Which of the ff is a reactivation and therefore not a risk to the fetus

Shingles

3 recurrent miscarriages during the first trimester in the last 12 months inv?

Antiphospholipid antibodies

After delivery, a woman develops lower abdominal pain and uterine tenderness. Large gram negative rods suggestive of clostridia are seen in the smear of the cervix. Which of the ff is most likely to proceed with hysterectomy

Gas gangre

Which of the ff explanation for the patient's decreased fundal height

Fetal growth retsriction

What are the tests included in the first trimester

Hepatitis B, HIV and Scrren the 1 hr glucose tolerance test should be perfomed between 24-28 wks of gestation.

Most appropriare intial management of Hypertension

Methyldopa

Grp B strep infxn in pregnant woman What is the treatment

Amoxicillin for 3 days

Which of the ff malpositons would require a cesarean section n the absence of fetomaternal distress and cephalopelvic disproportion?

Face presentation

Diagnose with primary genital herpetic lesions at multiple sites iin the genital area What is the most approp management?

Suppressive antiviral until delvery

Pregnant lady presented with exposure to rubella never been vaccinated against rubella What will you do next?

Check serum IgM and IgG for rubella

Most single warning sign of diminishing blood volume withinn the first 4 hours post partum?

Tachycardia

Not a complication of gestational trophoblastic disease

Infertility

Gestational trophoblastic disease can cause complications including

Uterine infection haemorrhagic shock Sepsis Pre-eclampsia Metastasis to the lungs

True statement regarding the mgt of DVT in pregnancy

Warafarin therapy is CONTRAINDICATED throughout pregnancy but safe during breast feeding

Complication of severe pre-eclampsia that overlaps with acute fatty liver in pregnancy

HELLP syndrome

Abdominal pain and genital bleeding, pregnant woman at 40wks gestation loss 400ml of blood Vital signs normal and as tender abdomen, no fetal heart sounds Nesxt step?

Amniotomy

Most approp stepfor the estimation of the fetal gestational age?

Transvaginal ultrasound at 8 wks

28wks pregnant with sudden gush of clear fluid Premature rupture of membranes with closed cervic mgt while transferring the patient to the tertiary care?

Bethamethasone

What is contraindicated regarding the Hepatitis C transmission

Fetal scalp blood sampling Breastfeeding is not contraindicated in Hepatitis C.

Breech presentation at 32 wks, had gestational diabetes and macrosomia, breech presentation for her baby Most appop advice?

Elective cesarean section

16 wks gestation with a history of lower vaginal pressure, vaginal spotting and lower back pain. TVS shows cervical shortening of 2 cm, cervical dilation and protrusion of fetal membranes into the cervical canal. Developed symptoms of cervical insufficiency that may lead to premature delivery. Most approp treatment?

Reinforcement of the cervicak ring with nonabsorbable suture material

Symptomatic and asymptomatic urinary tract infection in pregnancy tx?

oral amoxicillin with clavulanate or oral cephalexin for 7 days

Diagnosed with DVT at 18th wks of pregnancy Best mgt?

Therapeutic dose of LMW heparin for 6 months

Most common cause of cesarean section delivery in Australia

Previous cesearn section

Reason for the Rh sensitizatiom of the patient

Blood transfusion

UNLIKELY Predisposing factors for postpartum Hemorrhage

Oligohydramnios

Risk factor for recurrent pregnancy loss

Antiphospholipid syndrome

Best management for DVT in pregnant patients

LMW heparin

Not a contraindication for tocolysis

Asthma

Can be used in the screening test in both first and second trimester of pregnancy to detect Down Sydnrome

Free beta Hcg level

37wks gestation, sudden gush of clear fluid apart from giving antibiotics What's next?

Induce labor now

Contraindication to the vagiinal delivery for breech presentation?

Clinically inadequate pelvis

Gestational diabetes taking Metformin but was ceased after the birth of the baby four weeks ago What will you do?

Oral glucose tolerance test at 6-12 wks postpartum

Antenatal Advice Aside from folic acid, what else should be given to the pregnant lady

Iodine

Weight loss Moderate to severe dehydration ketosis Electrolyte abnormalities

Hyperemesis Gravidarum

Most common cause of post-partum hemorrhage

Uterine Atony

Most common cause of post-partum hemorrhage

Uterine Atony

Risk Factors for uterine atony:

Multiple pregnancy Polyhydramnios Macrosomia Prolonged labour Multiparity

Other causes of post-partum hemorrhage

Laceration of genital tract Uterine rupture Uterine inversin Coagulopathy

Most common cause of postpartum hemorrhage requiring hysterectomy

Placenta accreta

DOES Not increase the risk for dveeloping postpartum endometriosis

Advanced maternal age

A 34 yo woman who has been using oral contraceptive pills for the last 3 years. She is planning to conceive this year. Drinks regular alcohol. What is the most approp advice?

Stop Alcohol now

Which one of the ff would not increase the risk for cord prolapse during delivery?

Anemia

Not associated with maternal Vitamin D deficiency in pregnancy

Large for gestational Age

Maternal Vitamin D deficiency is associated with

Hypocalcemia in newborn Rickets Defective tooth enamel Small for gestational duet to effect in skeletal growth Fetal convulsions or seizures due to hypocalcemia

Rheumatoid arthritis pregnancy

STOP METHOTREXATE and continue SULFASALAZINE

Klympls palsy

C7, C8 and T1

hand and wrist paralysis Associated with Horner Syndrome

KLUMPLS PALSY

Rupture of membranes occurring < 37 wks gestation

PPROM

Defined as a rupture >18 hrss prior to delivery

Prolonged ROM

How to diagnose Rupture of membranes

A sterile speculum exam Nitrazine paper test - paper turns blue, indicating alkaline ph of amniotic fluid Second step: Ultrasound Never perform digital Vaginal exam

What is the treatment for premature rupture of membrane?

Depends on GA and fetal lung maturity If it is term: Induce labor >34-36 wks gestation: Labor induction may be considered <25-32 wks - Expectant management with bed rest Try to delay as long as possible so that he baby become more mature. A high vaginal swab is advisabe. Lung maturity -> mother -> steroid AntibioticsL Given to prevent infection Antenatal corticosteroids: BETHAMETHASONE or DEXAMETHASONE 48 hrs - promote lung maturity If there are signs of infection or fetal distress develop - Antibiotics and induce labor

Onset of labor between 20 and 37 wks gestation

Preterm Labor

Menstrual like cramps Low back pain, pelvic pressure Or new vaginal discharge or bleeding

Preterm Labor

How to diagnose preterm labor

Regular uterine contractions Concurrent cervical change Fetal fibronectin to confirm Sterile speculum exam to rule out PROM Ultrasound

What is the treatment for Preterm Labor

Hydration and bed rest 1st step - Unless contraindicated begin tocolytic therapy - B-Agonist, MgSO4, CCBs, PGIs Steroids - to accelerate fetal lung maturity

What are the contraindications to tocolysis

Infection - nonreassuring fetal testing, placental abruption, no contractions Fetus is older than 34 wks gestation Fetus weighs less than 2500 grams or has inrauterine growth restriction (IUGR) or placental insufficiency Lethal congenital or chromosomal abnormalities Cervical dilation is greater than 4 cm Chorioamnionitis or intrauterine infection is present Other cause of fetal distress or fetal death

What is the prophylaxis for GBS

Penicillin or Ampicillin

Sudden gush of fluid

PRO

Uterine contraction and dilatation of cervix

PRETERM LABOR

Most impt drug to the PROM

Dexamethasone

Important drug to preterm labor

Tocolytics

Most absolute contraindication to tocolytics

Chorioamnionitis

Key word of Chorioamnionitis

Maternal fever

Once chorioamnionitis occured

Sampling and antibiotics

Tocolytic drugs that are used in the clinical practice

Calcium antagonist - Nifedipine Oxytocin -receptor antagonists - Atosiban Inhibitors od prostaglandin synthesis - Indomethacin NO donors - Nitroglycerin Betamimetics - Fenoterol, Terbutaline, Ritrodrine Magnesium

Most common fetal malpresentation

Prematurity

Most common malpresentation

Occipito Posterior

The thighs are flexed, and the knees are extended

Frank Breech (50-75%)

One or both legs are extended below the buttocks

Footling breech (20%)

The thighs are flexed and the knees are extended

Frank Breech

One or both legs are extended below the buttocks

Footling breech

The thighs and knees aee flexed

Complete breech (5-10%)

Attempt only if delivery is imminent

Trial of breech vaginal delivery

Most common indication for CS

Previous CS

Most common cause of Priary C-section

Cephalopelvic disproportion

Prior classical C-section

Never to try vaginal delivery - UTERINE RUPTURE

What type of Episiotomy is the easy one

Midline

Which type of episiotomy is the hardest one

Mediolateral

Uterine shifts from midline Fetal body part more prominent Less bleeding more shock.

Uterine Rupture

Loss of > 500 ml blood for vaginal delivery or >1000 ml for C-section

Postpartum hemorrhage

Most common cause of Postpartum Hemorrhage

Uterine Atony

What are the other causes of Postpartum Hemorrhage

Genital Tract Trauma Retained Placental Tissue

Most common cause of postpartum hemorrhage

Uterine Atony

Palpation of a soft, enlarged, "Boggy" uterus

Postpartum Hemorrhage

What is the first step of treatment in Uterine Atony

Bimanual uterine Massage

What is the second step in Uterine Atony

Oxytocin Infusion

Puerperal fever is defined as raised temperature of >38 C from day 1 to day 10. If fever think of the 3cs - birth cana;, breast, bladder.

Postpartum infections

Characterized by: Temperature > 38 Deg C Uterine tenderness Offensive Lochia Timing : usually 2nd day or 3rd day

Postpartum Infections

What is the most common risk factor for Postpartum infections

C-section

Postpartum with amenorrhea can't breast-fed her baby. What is the diagnosis?

Pituitary Necrosis or Sheehan's Syndrome (Postpartum Pituitary Necrosis)

Anterior pituitary insufficiency secondary to

Massive obstetric Hemorrhage and Shock - Sheehan's Syndrome (Postpartum Pituitary Necrosis)

What is the most common presenting syndrome

Failure to lactate due to decrease prolactin levels

Weakness, lethargy, cold insensitivity

Decreased TSH

Genital Atrophy and Menstrual Disorders

Decreased FSH and LH

What are the treatment options for pituitary tumours?

Usually surgery in most cases except for Prolactinoma

Early breast milk Very rich in protein, fat,secretory IA and minerals

Colostrum

The 6Ws of postpartum fever

Wind (atelectasis) - first day Water (UTI) - 2nd -3rd day Womb (endomyometritis) - 2nd or 3rd Walk (DVT, Pulmonary Embolism) - after 5 days Wound ( incision, episiotomy) - After one week Weaning (breast engorgement, absecess, mastitis) - usually more than 10 days

A female postpartum presents with blood pressure 80/50 and pulse 120 with 400 ml blood loss. on examination there was deviated uterus. What is the cause?

Broad Ligament Hematoma - patient after labor with hypotension + contracted uterus + deviated uterus

The time of the onset of true labor until the ervix is completely dilated to 10cm

First Stage

The period after the cervic is dilated to 10 cm until the baby is delivered.

Second Stage

Delivery of the placenta

Third Stage

It is the longest and involves two phases

First Stage

The time of the onset of labor until the cervix is dilated to 4cm

Latent Phase

Continues from 4 cm until the cervix is dilated to 10 cm

Active Labor Phase

Early labor will last approx 8-12 hrs Cervix will efface and dilate to 4c, Contractions will last about 30-45 seconds, giving you 5-30 minutes of rest between contractions

Early Labor Phase

Active Labor will last about 3-5 hrs Cervix will dilate from 4 cm to 10 cm Contractions during this phase will las about 45-60 seconds with 3 -5 minutes rest in between

Active Labor Phase

Second stage of labor starts with ___ and ends with _____ with a total duration of ______

Starts with COMPLETE CERVICAL DILATATON and ends with the BABY DELIVERY and with the duration of 1 -3 hours.

The Third stage of labor starts with ____ and ends with _____ and the duration of _____.

Starts with the delivery fof the baby and ends with the delivery of the placenta and duration of Half an hour.

What is the treatment of prolonged Latent Phase

Sedation and rest

Cervix dilatation is around 2 cm with regular contraction

Prolonged Latent Phase

Cervix is dilated around 7cm and 2 cm change in 4 hrs Regular contractions

Prolonged Active Phase

Dilated around 7 cm with regular contractions

Arrested Active Phase

What is the treatment if HYPOTONIC

Oxytocin

What is the treatment if it is Hypertonic

SEDATION

What if it is Adequate

Regular contraction Fully dilated cervix No descent in 3 hrs

Second Stage of Arrest

If the contraction is weak what is the management

Oxytocin

If the head is not engaged in Arrest of labor, what is the management?

If teh head is engaged in Arrest of Labor, what is the management?

FORCEPS (nonrotating)

Increase FHR above the base line Less than 2 minutes Not related to contraction Always reassure

ACCELERATION

Fluctuation in the FHR Normally occurs (6-25 mins) If absent ---- Abnormal if marked reliability ----- Fetal distress

Variability

Normal range of Fetal Heart Rate

110 - 160

If less than 110

Bradycardia

If more than 160

Tachycardia

Most common cause of fetal Bradycardia

Sleeping baby

Most common cause of Fetal Tachycardia

Maternal Fever

Normal Fetal Ph

7.25-7.35

Gradual Drop in the FHR Gradual increase in the FHR Mirror image of the contraction Cause : fetal Head Compression

Early Deceleration

Gradual drop in FHR Gradual increase in the FHR Delay in relation to contraction Cause is : fetal hypoxia or Fetal Acidosis First Step is FETAL SCALP PH

Late Deceleration

Sudden drop in the FHR Sudden increase in FHR Severe if FHR is less than 60 ----CS Cause ---- CORD COMPRESSION

Variable Deceleration

When to say it is Normal Labor

Baseline 110-160 Acceleration and Variability is present Deceleration is absent

Less than 110 or more than 160 Absent acceleration Variability Absent Late or Variable devceleration is present

ABNORMAL LABOR

Lowest point after onset of an early or late deceleration and variable

NADIR

VEAL CHOP

Variable Early Acceleration Late Cord Compression Head Compression Okay or Mild Hypoxia Placenta Insufficiency

The degree of acidemia can be detected through

Sampling the fetalscalp blood to measure either scalp ph or scalp lactate

What is the Fetal Movement assessment

32-34 wks Normally 10 or more fetal movements in 2 hours

What is the first step in the abnormal fetal movements

History and Examination

First inv for the Abnormal Fetal movements

Fetal Heart doppler

Mgt if fetal heart rate is detected in Abnormal Fetal movements

CTG

If CTG is not available in the abormal Fetal movements

Refer to the hospital

If recurrent abnormal Fetal Heart movements, Near Term

Induction of labor

If recurrent abnormal FHM, away from term

Continuous CTG

Performed with the mother resting in the Lateral Tilt position FHR is monitored externally by Doppler

Nonstress Test (NST)

two accelerations of > 15 bpm above baseline lasting for at least 15 secons over a 20 minute

REACTIVE (normal response)

Fewer than two accelerations over a 20-minute period

NONREACTIVE

Uses a real time ultrasound to assign a score of 2 (normal) or O (abnormal) to five parameters fetal tone Breathing Movement Amniotic fluid volume NST

Biophysical profile (BPP)

Scoring is as follows for BPP 8-10 ?

Reassuring for fetal well-being

Scoring for BPP 6?

Considered equivocal. Term pregnancies are usually delivered

Scoring for BPP 0-4

Strong consideration should be given to immediate delivery

Fetal hips are flexed and the knees extended (pike position)

Frank breech

The fetus seems to be sitting with hips amd knees flexed

Complete breech

One or both legs are completely extended and present before the buttocks.

Footling Breech

One or both legs are completely extended and present before the buttocks.

Footling Breech

The baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees.

Kneeling Position

Is a transverse lie if the fetal long axis is oblique or perpendicular rather than parallel to the maternal long axis

Fetal Position

Oligohydramnios first diagnosed in the third trimester is often associated with

PPROM or with Uteroplacentak Insufficiency due to conditions such as Preeclampsia or other maternal Vascular diseases.

Management of gestational Diabetes

75g oRal Glucose tolerance test performed 6-8 wks after delivery

Right iliac fossa pain on getting up the chair and has been coughing and sneezing No Mass palpable and no rebound tenderness What is the cause?

Round Ligament Strain

Tx for UTI in pregnancy

Cephalexin (Co-Amoxiclav and Nitrofurantoin can be used safely in pregnancy)

Safest treament for Acute Migraine causing headache and vomiting

Paracetamol and metoclopramide

TVS shows cervical shortening to 2 cm, cervical dilation, and protrusion of fetal membranes into the cervical canal. What is the most likely diagnosis?

Cervical Insufficiency

Contraindication to Vagina delivery in breech presentation at term

Anemia

Cervical os is closed Endometrial thickness of 2mm and an empty uterus Adnexa are clear and there is no fluid in the pouch of Douglas

Complete Abortion

Most serious diagnosis of hyperemesis gravidarum

Hypokalemia

Which of the ff complications develop if Warfarin is used in second trimester of pregnancy?

Fetal Optic Atrophy

What food should be avoided during pregnany

Soft cheese

Abnormalities not seen in a pregnant woman with hyperemesis gravidarum

Hypothyroidism

Dilated cervic as well a progressive uterine bleeding and painful uterine bleeding contractions The gestational tissue often can be felt or seen through the cervical os and passage of this tissue typically ocurs within a short time.

Inevitable abortion

Membranes may have ruptured and the conception products may have pastly passed, but significant amounts of placental tissue is still left in the uterus. Cervical os is open, uterine is not well contraccted. Gestational tissue is observed int he cervix. Uterine size is ssmall than expected

Incomplete abortion

Refers to o utero death of the embryo or fetus prior to 20 wks gestation Women feel that they dont feel pregnant anymore Vaginal bleeding may occur and the cerix usually remains closed.

Missed abortion

Miscarriage occurs before the 12 wks and the entire contents of the uterus is expelled. Uterus is small on PE and well contracted with an open or closed cervix. Scant vahinal bleeding and only mild cramping Ultrasound will reveal an empty uterus and no extra-uterine pregnancy

Complete Abortion

Screening markers used for both first and second trimester for screening for Down Syndrome

Free Beta HcG level

Increased in size but not blood supply Total T3 and T4 increased Free T3 nd T4 is normal

Sheehan Syndrome

Loss of products of conception before 20th week of pregnancy

Abortion

What is the most common cause of Abortion?

Chromosomal Abnormalities

Inhertied thrombophilies associated with abortion

Factor V leiden

No POC is expelled Uterine bleeding +/- Abdominal pain Closed os + Intact membranes + fetal cardiac motion on ultrasound

Threatened Abortion

What is the treatment of Threatened Abortion?

Pelvic rest for 24-48 hrs No sexual relationships Progesterone

Completely expelled No pain No bleeding Closed os Emty uterus on ultrasound

Complete Abortion

Expelled some POC There is bleeding and pain Open os Ultrasound shows retained Fetal tissue Manual uterine Aspiration or D and C

Incomplete

No POC is expelled Uterine Bleeding There is Pain Open OS. Ultrasound shows retained fetal tissue. Manual uterine Aspiration or D and C

Incomplete

No POC is expelled No fetal cardicac motion No uterine bleeding No pain Closed os No detal cardiac activity retained fetal tissue on ultrasound

Missed Abortion

Endometritis leading to septicemia

Septic Abortion

Main Treatment of septic arthritis

Antibiotics then curettage

What is the main risk with curettage of Septic Abortion

Perforation of Uterus

Main treatment of Threatened abortion

Rest

Most common cause of Abortion

Chromosomal

What is the timing of abortion with chromosomal disorders

First Trimester

What is the TTT of abortion in first trimester

Dilataion and Curettage

What is the TTT of abortion in second trimester

Dilatation and Evacuation

What is the best way to assess the gestational age in the first trimester

Nonviable pregnancy without vaginal bleeding, uterine cramping or cervical dilation

Missed abortion Mgt: Scheduled suction D & C Conservative management or induce cotnrations with Misoprostol

Viable pregnancy with vaginal bleeding but no cervical dilation

Threatened Abortion Mgt: PFten the cause is Implantation bleeding

Vaginal bleeding and uterine cramping leading to Cervical dilation but not POC has yet been passed.

Inevitable Abortion Mgt: Emergency Suction D&C if bleeding is heavy to prevent further blood loss and anemia Misoprostol

Vaginal bleeding and uterine cramping leading to cervical dilation with some but not all, POC having been passed.

Incomplete Abortion Mgt: Emergency Suction D & C Cytotec or Misoprostol - inuce contractions

all POC being passed

Conpleted Abortion Confirmed by USG B-HCG should be obtained weekly

Most common cause of fetal demise

Idiopathic

What is the risk of Fetal Demise

DIC

Condition of intrauterine fetal growth slowing Caused bu infant nutrition and general life support Intrinsic factors in the fetus itself

Intrauterine Growth Retardation (IUGR)

It is caused by Placental Insufficiency

Asymmetric IUGR

recurrent abortion and IUGR Second trimester Antibodies: Antiphospholipic, Anticardiolipin Most commen congenital abnormaltyL Heart Block

SLE with pregnancy

What is the treatment needed for SLE with prenancy

Low dose Aspirin Low Dose Heparin (LMWH)

Painless dilation of the cervix Delivery of Normal baby who quickly dies (premature delivery) Timing: Second trimester Painless leakage of amniotic fluid in second trimester often diagnosed with USG

Incompetent Cervix

What are the causes of Incompetent Cervix

History of conization LEEP Diethystilbestrol Exposure

What is the ultrasound findings for the incompetent cervix?

Shortening of cervix Herniation of Fetal Membranes

What is the TTT of Incompetent Cervix

Cerclage

Large ketonuria Weight Loss Electrolyte disturbances Ptyalism (excess salivation)

Hyperemesis Gravidarum

What are the risk factors for Hyperemesis Gravidarum

Molar Pregnancies Multiple Gestations UTI