Obstetrics and Gynecology Key Notes

Obstetrics and Gynecology Key Notes

• DEPO PROVERA is a 3-month injectable contraceptive, and patients should be assessed for weight gain.
• FESO4 dosage is 1 gram per singleton pregnancy, starting at 5 months and continuing until 2 months postpartum.
• The MDG target aimed for a reduction in maternal mortality to 80 per 100,000 live births (MDG5).
• There was also a goal for a 2/3 reduction in the child mortality rate (MDG4).
• MDG 5 had a target date of 2015.
• SDG-17 has goals targeted for the year 2030.
• A fetal head in the flank indicates a transverse lie presentation.
• Funic souffle is a blowing sound synchronous with fetal heart sounds, potentially originating from the umbilical cord; also known as funicular or fetal souffle.
• Uterine souffle is a sound synchronous with the maternal pulse, produced by blood in the uterine arteries.
• Funic souffle is the sound of blood rushing through umbilical vessels synchronous with the fetal pulse.
• Goodell's sign is the softening of the cervical tip, typically observed around the 6th week in a normal, unscarred cervix.
• Cardinal ligaments (Mackenrodt's) attach the upper vagina, cervix, and uterus to the side walls of the pelvis.
• Acetic acid is vinegar.
• Round ligaments attach the uterus to the mons pubis.
• Broad ligaments attach the uterus to the medial aspect of the ilium.
• The submento bregmatic is the widest or largest APD of the fetal head, with the chin as the presenting part.
• Left and right occipito-anterior positions are the only normal fetal presentations.
• Occipito-posterior is considered a malposition.
• Malpresentations include any presentation other than vertex, such as face, brow, breech, shoulder, cord, and complex presentations.
• Dextro-rotation of the uterus, which rotates anti-clockwise, favors occipito-posterior in right occipito-anterior positions.
• Dextrorotation is similar to clockwise rotation.
• A longitudinal stomach at 3 o'clock indicates a transverse head on the maternal right side.
• A longitudinal stomach at 9 o'clock indicates a transverse head on the maternal left side.
• A pendulous abdomen can be a sign of malpresentation of the fetus.
• Anthropoid and android pelvises are the most common causes of occipito-posterior positions due to a narrow fore-pelvis.
• 0 Station is when the biparietal diameter is at the pelvic inlet, and the fetal head is fully engaged.
• Suboccipitobregmatic is the shortest APD with the vertex or occiput as the presenting part.
• FSH matures follicles for the release of estrogen.
• Melanocyte-stimulating hormone causes dark pigmentation of the skin, like melasma and linea nigra.
• For EDC computation, if the LMP falls between January and March, add 9 to the month and 7 to the days.
• If the LMP is between April and December, subtract 3 months, add 7 days, and add 1 year.
• Leopold's Maneuver determines the attitude, fetal presentation, lie, presenting part, degree of descent, estimated size and number of fetuses, fetal position, fetal back, and fetal heart tone.
• The first action in Leopold's Maneuver is to have the patient empty their bladder to promote comfort.
• Leopold's Maneuver involves positioning the mother supine with knees flexed (dorsal recumbent or genupectural) to relax abdominal muscles.
• Draping properly can provide privacy.
• Instructing the patient about the procedure promotes cooperation.
• Warmed hands provide comfort for the patient.
• The first three Leopold maneuvers are performed facing the mother, and the last maneuver is performed facing the feet of the mother.
• The 1st maneuver involves placing the patient in a supine position with knees slightly flexed, and using a towel under the head and right hip, with both hands palpating the upper abdomen and fundus, assessing size, shape, movement, and firmness to determine presentation.
• The 2nd Maneuver is done with both hands moving down to identify the back of the fetus (to hear the fetal heart sound) where the ball of the stethoscope is placed to determine FHT and get.
• V/S(before 2ndmaneuver) PR differs between the fundic souffle (FHR) & uterine souffle.
• Uterine souffle corresponds to the maternal heart rate.
• The 3rd Maneuver uses the right hand to grasp the symphysis pubis part using thumb and fingers to determine the degree of engagement.
• Engagement is assessed to see if the presenting part is engaged in the pelvis, if the head isn't movable.
• The 4th Maneuver requires the examiner to change position by facing the patient's feet and assessing the descent of the presenting part by locating the cephalic prominence or brow to determine the attitude of the fetus.
• Flexion occurs when the chin touches the chest.
• Leopold's maneuver 1 involves fundic height assessment and AOG (Age of Gestation) assessment.
• LM2 in Leopold's Maneuver assesses fetal heart tone
• LM3 involves assessing for a non-movable hard mass, which indicates an engaged baby.
• LM4 of Leopold's Maneuver involves facing the mother
• LM1 indicates that breech palpation is cephalic.
• LM2 suggests palpation of the head or a round, hard mass indicates a transverse lie.
• Leopold's maneuver is best performed with the mother in the dorsal recumbent position.
• LM1, the fundal grip, helps determine fetal presentation, AOG, and fundic height.
• Nodular, angular parts palpated in LM1 indicate a baby in shoulder presentation and transverse lie.
• In Lm2/ umbilical grip, the fetal back, lie, and position are assessed by grasping the side of the abdomen.
• Lm3 assesses fetal engagement/ballottement using the pawliks grip by grasping the lower abdomen.
• In Lm4/pelvic grip the fetal descent, attitude, fetal cephalic prominence, and presenting part are assessed.
• The inguinal region is grasped facing the feet of the mother
• The level of the Symphysis pubis indicates 12 weeks of gestation
• Midway between the symphysis pubis and umbilicus indicates 16 weeks of gestation.
• The level of the navel or umbilicus indicates 20 weeks.
• Just above the navel indicates 24 weeks.
• Just below the navel indicates 16 weeks.
• Midway of the navel and xyphoid indicates 28 weeks.
• The level of the Xiphoid process indicates 36 weeks.
• Heartburn/pyrosis during pregnancy is managed by avoiding acidic beverages like citrus juices, calamansi, and lemon.
• It is also advised to avoid ilk, tea, coffee, odorous, fatty, greasy foods.
• Ectopic pregnancy may present as an adnexal mass.
• An ectopic pregnancy may present as sudden sharp stabbing lower quadrant abdominal pain that radiates to the shoulder or neck.
• Ectopic pregnancies can also present with spotting, bleeding, a mass in the lower quadrant of the abdomen, nausea, vomiting, and dizziness.
• Lochia rubra is present for the first 3 days only, appearing red due to a higher erythrocyte or RBC content.
• Lochial serosa is present from days 4-9, appearing pink to brown with leukocytes or plasma.
• Lochia alba is creamy white and lasts from 10 days up to 6 weeks postpartum.
• Lochia should be free of foul odor, blood clots, fever, and chills, as these symptoms indicate puerperal sepsis.
• A recto-vaginal fistula is an abnormal opening or communication between the rectum and vagina.
• Kegel exercises strengthen perineal muscles and should be done 3x a day for at least 10-15 repetitions in sitting and standing.
• The secretory phase is associated with progesterone.
• The proliferative phase is associated with estrogen.
• Iron sources include liver products, kidney beans, lima beans, and lentil beans.
• Meconium is a tar-like, odorless, blackish first stool of the baby, typically passed within 24 hours after delivery.
• Breastfeeding provides colostrum and antibodies, and the breastmilk can be stored safely.
• Back pain in the mother can be relieved by pelvic rocking and squatting exercises.
• Magnesium sulfate (MagS04) antidote is Calcium Gluconate.
• Braxton Hicks contractions are intermittent, painless, irregular, false or practice labor contractions.
• IUD insertion is a long-term reversible method of contraception.
• An IUD is inserted during menstruation or 1-4 days after delivery and is placed in the uterus.
• Presumptive signs of pregnancy include amenorrhea, morning sickness, nausea, and vomiting less than 12 weeks.
• Uterine contractions should be rhythmic and regular.
• The Vitamin A IU dose for a postpartum mother is 200,000 IU.
• A pregnant mother should not take more than 10,000 IU of Vitamin A at 4 months pregnancy, 2x a week.
• Tetracycline use during pregnancy can cause discoloration of the baby’s teeth and bones, leading to permanent GREEN Teeth.
• DEPO PROVERA is a 3-month injectable contraceptive, which requires assessment of weight gain.
• HCG is tested for positive pregnancy test results.
• A diagnosed hydatidiform mole (hmole) appears as round masses on ultrasound.
• Progesterone is associated with pyrosis, pregnancy, and ovulation.
• Lordosis, back ache and waddling gait are related to Relaxin hormones.
• Preterm labor is labor before 37 weeks
• Dexamethasone, betamethasone, and celestone are drugs given in preterm labor to mature fetal surfactants.
• Postpartum hemorrhage within 6 days of bleeding or more suggests retained fragments of conception.
• Ectopic pregnancy causes sharp sudden stablike pain in the lower quadrant of the abdomen and spotting bleeding.
• Pseudocyesis is a false pregnancy.
• The cervix consists of squamo-columnar cells.
• Quickening, the first fetal movement, occurs around 16-20 weeks of gestation.
• The ectoderm gives rise to sense organs and the brain.
• The endoderm forms the lining of the GI tract and the liver.
• The mesoderm develops into the uterus, ovaries, blood cells, and the heart.
• Input, output, RR, Weight and Height are not assessed using a Partograph.
• Assessed via partograph are fetal wellbeing, maternal wellbeing, and progress of labor.
• A central feature of a partograph is cervical dilation.
• Internal Examinations (IE) are done every 4 hours.
• The active phase of labor begins at 4 cm cervical dilation.
• Postpartum hemorrhage involves blood loss of 500-1000ml.
• Postpartum hemorrhage is managed by massaging the fundus and administering 10 IU of oxytocin.
• Effleurage is backrubbing during labor.
• A thickening of the uterus is associated with estrogen.
• A secretory endometrium is good for implantation.
• Secretion of the endometrial lining is related to progesterone.
• Hcg is identified using a positive pregnancy test
• Hcg is connected to morning sickness.
• Follicle-stimulating hormone (FSH) matures egg cells or primordial follicles to graafian follicles.
• Melanocyte-stimulating hormone causes dark pigmentation of the skin, such as linea nigra and chloasma.
• An android pelvis is considered a heart-shaped (male) pelvis.
• A gynecoid pelvis is permit vaginal delivery, is wide and deep, and is apple-shaped (typically female).
• The sex of the fetus can be identified at 4 months or 16 weeks.
• The Fetal heart rate (FHT) is in the range of 120-160 bpm; it can be taken above the umbilicus for a breech presentation.
• Ectopic pregnancy presents with lower abdominal sudden knifelike pain that radiates to the shoulder.
• Pseudocyesis is a false pregnancy resulting in amenorrhea.
• The cervix consists of squamo-columnar cells.
• Quickening occurs at 16 weeks in multiparous women and 20 weeks in primiparous women.
• The three germ layers are: Ectoderm (sense organs, hair, nail, skin, brain and nervous system), Endoderm (GIT and respiratory lining, thyroid and parathyroid), and Liver and internal organs except the uterus.
• The Ritgens maneuver controls fetal head delivery.
• Kegels strengthen the levator ani muscles, which are pelvic floor muscles or perineal muscles, and are mostly benefited is the pubococcygeus muscle.
• PROM is a Premature Rupture Of Membranes and for more than 20 hours the mother's temperature must be checked as there is a risk of infection.
• I.E is done every 4 hours
• Amenorrhea is a presumptive sign of pregnancy.
• Vitamin A/Retinol-rich foods include Squash, Papaya, Yellow Camote, Egg Yolk, and Ripe Guava.
• Also retinol rich are Mango, Fortified Cereals, legumes, and beans,
• Iodine prevents cretinism or mental retardation.
• Dietary sources of iodine: iodized salt, talaba oyster, anchovies or dilis, shells, clams, seaweeds.
• A hot Sitz bath, lasting 15-20 minutes.
• A hot sitz bath procedure involves a patient's perineal area submerged in water with solutions depending on client's needs.
• It can involve a bath in which only the pelvic area is immersed in warm fluid (38-42 celcius).
• Indications for hot sitz baths include: Hemorrhoids, Anal Fissures/Surgery, Episiotomy or laceration, and Uterine Cramps.
• Contraindications: Pregnancy, Menstruation
• Afterpains are normal during the first few days after delivery.
• Contractions resemble menstrual cramps preventing excessive bleeding by compressing the blood vessels in the uterus.
• This scenario is common in breastfeeding primigravidas.
• Iron prevents anemia of pregnancy through its use in Liver Products, Red Meat, Internal Organs, Monggo, Green Leafy Vegetables.
• Vitamin D aids calcium absorption, preventing RICKETS in children and osteomalacia in adults; sources include dairy products, fish, milk, cheese, anchovies, salmon, and sardines.
• Trichomonas vaginalis caused frothy creamy strawberry-like dishcharge and treated for by flagyl or metronidazole.
• Moniliasis, candidiasis, albicans-related yeast infections – itchy, white cheesy discharge, pruritus vulva (vaginitis).
• KOH test or potassium hydroxide test is a method for moiniliasis diagnosis.
• Hepatitis B gets acquired through blood or needle sticks... at sex (use one needle per patient).
• Syphilis presents with painless sores, ulcers.
• HPV presents with condylomata- cauliflower CELLS.
• Postpartum blues are common and normal
• Oxytocin is responsible for uterine contraction
• Inevitable Abortion is signified open cervix
• At 20 Weeks the fetus sleeps, awakes and can hear sound
• Menopause is climacteric or change of life
• Endometriosis involves ectopic growth or growth of endometrial tissue outside uterus – most common site - ovaries – Drug of choice : Danazol – methotrexate and hormonal therapy – common to postmenopauseal.
• Accutane or tretinoin are anti acne medications contraindicated in pregnancy
• Penicillin and amoxicillin are classified the safest antibiotics of pregnancy
• Rubella vaccines are contraindicated in pregnancy
• A complication of streptomycin in pregnancy is a deaf baby or abortion.
• A complication of chloramphenicol in pregnancy is gray baby syndrome.
• A complication of smoking in pregnancy is SGa or Low birth weight baby.
• A complication of DM of mother is macrosomia and preterm baby.
• The mother positioned in lithotomy is best for the IUD.
• The mother positioned side lying is best for in labor.
• The mother positioned dorsal recumbent is best forLeopolds.
• The mother positioned-trendelenburg is best for vaginal bleeding.
• The mother is positioned knee chest or trendelenburg for Ruptured BOW
• The mother is positioned trendelenburg in shock cases.
• The mother positioned knee chest or trendelenburg is useful for cord prolapse.
• The mother positioned left side lying help with the fetal distress.
• The mother positioned sitting can use BED PAN
• The mother positioned Supine facilitates the BSE.
• The man positioned standing after warm bath is ready for TSE
• The mother positioned lying on the side is best for CS in Breast feeding- side lying
• A mother chatting while Breast feeding – sitting
• A mother in NSVD breastfeeding-is positioned Cradle hold
• Stored milk stays good for 4-6 hours if kept in room
• Stored milk stay good for 6 months if frozen
• Treat Mastitis – with a cold compress before feeding
• Treat Engorgement – with warm compress before feeding
• Do not wash the breast with soap
• Breastfeeding should begin immediately or within 30 minutes after birth and after 3-4 hours in CS
• EO – 51 is milk code for no pacifiers and prelacteal feeding like sugar waters and formula
• RA 7600- Rooming in and breastfeeding act which was enacted on June 2, 1992.
• Normal Spontaneous Deliveries happen-
• The newborn infant is immediately put to the breast of the mother.
• The infant becomes roomed in within thirty (30) minutes.
• Republic Act 10028 or the “Expanded Breastfeeding Promotion Act of 2009”
• The kidney bean-shaped pelvis is named Platypelloid
• The oval-shaped pelvis is named Anthropoid
• The flat pelvis is named Platypelloid
• The round/sphere/discoid pelvis is named Gynecoid
• The heart-shaped pelvis is named Android
• The apple-shaped pelvis is named Gynecoid
• The rarest pelvis is named Platypelloid
• A wide APD with a narrow TD corresponds to an Anthropoid pelvis.
• A wide TD with a narrow APD matches the Platypelloid pelvis.
• Globular abdomen is the 1st sign of separation
• Gush of blood of the 2nd sign of separation of placneta and amniotic sac.
• Red rubra describes a separation happening.
• Serosanguinous discharge described a serosa - pinkish discharge
• Prolactin is responsible for milk production
• The third trimester prepares motherhood to parenthood roles by accepetence.
• Taking in- egocentric or self centered mother
• A transverse diameter is an AP > T
• BBB describe 1.Tranverse Diameters
• The Biparietal line is the most important TD
• The greatest diameter presented to the pelvic inlet's AP and at the outlet's TD
• The Avarage Biparietal line is measured at 9.5 cm
• The Bitemporal measurement is - average at 8 cm
• The Bimastoid measurement is - average at 7 cm

2. Anteroposterior Diameters SOO Suboccipitobregmatic – smallest APD fully flexed (presenting part)

• The best fetal position is the LOA (Left Occipitoanterior)
• A fetus in vertex presentation (occiput)
• A fetus typically accommodates itself on the left because of the placement of the bladder is at the right
• LOP/ROP – mother suffers more back pains
• The FHT breech is locate in the Upper R or L Quadrant (above the Umbilicus)
• The FHT Vertex is located in the Lower R or L Quadrant (below the Umbilicus)
• Station (STATION) is defined relationship of the presenting part of the fetus to the ischial spine of the mother. Minus (-) station is referred when the presenting above the ischial spine Zero (0) station means the presenting at the level of the ischial spine Positive (+) station means the presenting past the level of the ischial spine Floating occurs when the head is movable above the pelvic inlet   +1 station means – fetus is engaged +2 station – fetus is in midpelvis +4 station – perineum is bulging Another word Submento bregmatic is named the widest (or largest) APD The CHIN is the presenting part during birth.
• Left and right occipito-anterior are the only normal presentations and positions.
• Occipito-posterior is considered a malposition.
• Malpresentations are anything except vertex as face, brow, breech, shoulder, cord and complex presentations.
• Suboccipitobregmatic- shortest APD – presenting part – Vertex or OCCIPUT
• FSH triggers the RELEASE OF FOLLICLES andestrogen
• Support any baby with acleft lip in upright position and feed gently using commercial cleft lip
• Give cleft lip babies nipple which features (Breck feeder or Haberman)
• Breastfeed 7-10 days after surgery
• Bubble can help the infant after feeding
• Offer sips of fluid between feedings (keeps mucous membrane moist & prevents cracks & fissures)
• A child with cleft palate requires no special assistance.
• Use a commercial cleft palate nipple with rubber to feed babies with cleft palate
• Offer soft food (if surgery has to be delayed beyond (6 mos)
• Use tape with Cleft lip on
• Turn infant lateral to the repair or on back (to prevent pressure on suture line)
• the Suture line is held by a Logan bar
• Avoid infant crying as much as possible
• Palates with *Cleft
• Keep elbow restraints
• Do No spoon & straw during feeding
• Position babies to Keep on prone position
• Pyloric Stenosis involves – hypertrophy of the muscle surrounding the pyloric sphincter Sx include  Projectile vomiting immediately after feeding sour, no bile Hirschsprung’s Disease/Aganglionic megacolon
• Hirschsprung’s results in an absence of ganglionic innervation to the muscle of a section of the bowel no peristaltic waves
• Sx of bowel disorders and Chronic constipation
• Stools that are Ribbon like
• Failure to pass meconium by 24 hrs
• How many percent of neonatal deaths occur in the first two days of life?- 50%
• Evidence-based Package are practices, a series of time-bound, chronologically ordered, standard procedures that a baby receives at birth. this is known and EINC Protocol
• The protocol is Four Core Steps in EINC first 30 seconds-= Immediate and thorough drying to stimulate respiration occur after 30 seconds-= Early skin-to-skin-contacts Within first 1– 3 mins does Properly timed cord clamping within 90 mins = Non-separation of newborn from mother for early breastfeeding
• Immediate newborn care place?- 90 minutes The essential newborn care occurs ?-90 minutes to 6 hours The Functions of immediate and thorough drying

Stimulates breathing Prevents hypothermia The general perception for skin-to-skin contact is that Bonding happens The Other benefits of Skin contacts is

•  breastfeed with success
• Lymphoid tissue system is stimulated
• Exposure to stimulate maternal skin flora and regulates Sugar to prevent hypoglycemia.
• The Skin contact Thermoregulation
• The Best cord clamping happen best when cord pulsations have stopped
• Immediate cord clamping is done only when the baby is.
• Antenatal steroids should be administered to all patients who are at In distress or is Asphyxiated Active management of the 3rd stage of the labor includes :
  • Oxytocin after delivery of the baby Controlled cord traction Uterine massage -Oxytocin is given after the  excluding 2nd baby every 15 minutes for the first1-2 hours The Bathing of the baby is postponed until at least 6 hours Covering and wrapping with a warm blanket prevents CONVECTION heat loss DRYING prevents EVAPORATION HEATLOSS