OBGYN 20th Notebook PDF

OBGYN 20th Notebook By-Shransh OBSTETRICS Fertilization & Ampulla of Fallopian Tube (Full-term pregnancy) Nuchaltranslucency scan-11-13 wh 6 days + Da...

OBGYN 20th Notebook By-Shransh OBSTETRICS Fertilization & Ampulla of Fallopian Tube (Full-term pregnancy) Nuchaltranslucency scan-11-13 wh 6 days + Day afterfertilization 39-40wky + 6dayB Anomaly targetscan-18-20 why : zygote (Morula) 1-3 8-16 celled Placental 3rd trimester > - localization -> Day > - Blastocyst y formation. scan Day Implantation. Areuploidy (Donis) C 6-10 - > if >, 3 mm > - &It , STPAL System G Total. of times concieved forTTS * : : no marker Early * *Cystic Hygromsa b c · (Twins 1) - - = T: No of Term deliveries (73Twks) ↳ Next s Aneuploidy.. P: No. of Pre-Term deliveries (20-36 -(4) ① Karyotyping/FISH A: ⑧ Fetal Echo No- of abortion (< 201KD) L : No-of living children (twinp 2) = * Estimation of Gestational Age : - (used Will days) CRL < 84mm T , > - CRL 11 WRB + or + &montha * DD : day of LMP + + Tdays CRL in mm + 42 = Gest Age. in days. 1 Tdays 9months. day of LMP + BPD > HC if Feb TL- > - + Expected EDD : Presumptive EDD + (Cycle length-28) i - FL + BPD + HC [Single Best = FL] For Date of oocyte retrieval + 256 days (Fresh) yelex Abdominal Circumferent IVF : Fetal Growth by USG. * Estimation of > - Date Frozen cycle > - Dz transfer = of Dz transfer + 263 Hockey > - Stick Sign (Portal Sinus Umbilical vein Ds tranfer = Date of Ds travefor + 261 stomach is visibile) USG (Crown Length) of Weight Estimation For irregular cycles > - Rump * ↳ Best > - Johnson formula USE - Hadlock/Shephard formula * Signs of pregnancy :· Best A Single 6 Goodell's Soft > - carvin wks Chadwick -> Blue colour Vag 8 wky # Macrosomia - - Weight of Jetux > , 4 kg Osiander > - Lateral Vogwall pulsation 8 WKX RIF Post term pregnancy Diabetic Mother - Dr : Al >, 35 cm on USS Palmer Uterine Contract > - Rhythmic 8 why Male Fetus MOD : Vaginal Maternal Pisakeck Uterus ↑ Obesity C-section > - In diabetic mother we n Sky Unequal. > - 8 wky Non diabetic mother , of y, 5 by Hegar > - soft isthmus 6-10 why I Placental Hartman: > - Bleeding on implantation * Height of uterus decreases by I finger breath) day 24 try after delivery. Intradecidual Double Decidual Double Bleb Sign - first movementfelt Sac Sign Sign quickening -> fetal in primigravida > - 18-20 weeks Hockey in 16-18 weeks. Stick Multigravida > - > - Fetal Heart sounds -> By doppler at 10 weeks Sign pt > - USG - Intradecidual Sign sign on > > - 1st structure seen - > Gestational Jac  Spina Bifida Duodenal Atresia Posterior Urethral Value Anencephaly 2. IOC > - TVS 1. Lemon Sign 1. Double Bubble Sign 1. Key Hole Sign IMickey Mouse 2. Shower Cap Sign C. Meningeocode 2. Leads to polyhydramnios. 2 Associated with Oligo hydram sign. or 3. ↑ 10 weeks. does not T, Abortion # Thrombophelia cause * Infections can lead to Spontaneous Abortion O S LEscept Hv] * Infections does not cause Recurrent Pregnancy Loss. * Four Established Causes of Recurrent Pregnancy loss Anencephaly Spina Bifida ① APLA Syndrome (T2TTI) 8 O Uterine Structural Abnormalities go ⑧ Chromosomal Abnormalities. ⑨ Hypothyroidism ROL * Investigation for : antibodies ① Ultrasound ② APLA ③ TSH ④ Parental Karyotype Duodenal Sign Key Hole Sign # Cervical - Incompetence Patient - -↓ - Patient with Ho, 2 T2 Pregnant Female H/0 Abortion NonPregnantd no Painten abortions but No Trim / - 1 is abortion Length of Cervise is Abortion at verup Preg. Pregnant Pregnant+ at 16 16 < 2 5 cm. - ↓ 8 weeks weeks Cervical length ↓ ↓ 2/2 dilator No. 8 Hegar through (16-c4WRD) am Koesteron TVs internal OS/16 No Jolly ↓ · C with 1ml water catheter No investigation pull out. if Length >2. 5 cm + Progesterone to ↳ if Length 12. 5 cm > - Progesterone Mogesterone t ↑ LASH + Cervical Vaginal > - LASHG Cervical Cercelage : Abdominal - > Laproscopic correlage. 4- 14 WRs) cerlage - 12-14 was Types of Abdominal Coreslaye * Time to apply Satures > - * Pregnancy 2/1 ↳ Durfee Lapposcopic 3 months * After LASHGLASH SX -- is for. Bensen , , ↳ Never done in Pregnant females. # Oligo hydramnios # Polyhydramniop # PALENTA - ① AFI < 5 cmy ① AF1 : 7 25cmy , at which ② Sup < Cem ② Sup y, som Gestational age Fetal not M/C Renal Anomalies not of placenta = in Tz > - M/Cause of Severe Poly - > GITAnomalies. UPI/ PROM is M/( in Tz > - 2ndm/ - Neural Defects weeks My of Severe Oligo : Congenital Renal Abdominal * Maternal side ip formed by Anomalies * E defects * Decidea Basalis & Duodenal Atresia : Omphalocels M : Severe Oligo/Polyhydraming = Esophageal Atresia ) Gastrochipiy * Fetal Side is formed by ↓ Obstruction : Intestinal Chorion Frondosum use = Cleft Lip/Palate * Human Placenta is - Normal Congenital Anomaly TORCH also lead to Avoid Deciduate motorial ↓ ↓ * infections Can Pls enam Karyotyping Oligo 7 Poly in T2 * Afformones Secreted : t Colour Doppler * Indomethacin is used to treat 1) HCG 1) HOL 11) Progesterom iv) Estriol (E3) # Complications Polyhydramis , but should not Early 14 Life Placeta - > LUA RUA 32 weeks. Vessels T2 > - Pulmonary Hypoplasia be given after LUV Limb reduction ↓ Later Placata Venes RUV * Can lead to Premature Potter's Syndrome - RUA LUA LaV Closure of ductuy Arteriosus. , , T2 - > Lord Compression Battledore FMeconiumAspiration a * ther Associations H similar to (H. dif Upl lUGR ① functionally Succenturiate : dIt PROM : Amniotic Band ② Produced by : Synctiotrophoblast - - Syndrome z Blood ③ App in : 8-9 days ofFertilization. Digital Amputation Phocomelia is increased in * In * H24 Proximal Limb Amputation Bilobata > - Downs Jyn Placenta - - is seen d/t injection > - Twin Pregnancy o ALIDOMIDE - Molar - Pregnancy -> Gestational Trophoblastic Neoplasia Per Vaginal. * Examination is 6/1 in Circumvallete Ruptered Membranes. in - in decreased * HCG > - Abortions > - Ectonic Pregnancy Frisomies other then Circummarginate > - - trisomy 21  Oral < wkp D. T Milpristone 200 my Syndra at > - #LA ->. # > - · · Lupus Anticardiolipin Antibody > - 7-12 woky - Medical Abortion > Suction Evacuation > Misoprost400 moae 7-9 woks Antip 2 Glycoprotien 7 12 wk > - Abortion using Misoprost · > - ↳ Oral T Mifepristone Coo my it inhibits trophoblast Juncer. ↳ T Misoprost 800 may oral/buccal ↳ Ensure Process is complete * Diagnostic teria Mod SAPPARO. SYDNEY Criteria Criterial & Clinical + 1 Lob Criteria Thrombosis Episode of (Both used for Suction) > - are >, 3 losses at /10 weeks > - fetal Evacuation losses at 7/10 weeks Vaccum Manual > - > / letal ↓ * Done best between Aspiration > > - / Preterm delivery before 32 coke * d/t UPI , (UGR eth [T-12 cors] (660mmHg) * Lab Criteria 3 antibodies > - Any one of the + ve on 2 occasions 12 wky apart. MADLANancy Loss]ASPIRIN No No Pregnancy Thrombotic Event 2) ⑦ Pregnancy ⑦ Thrombotic Event Loss JASARIN HEPARIN Ectopic ve n e Pregnanu Triad of Pain Abdomen + Bleeding P/V + Amenorrhea (6) DonPregnantwith na 3) Ruptured ruptured I # # Preg. => Ectopic Shoulder tip Pain + 101 > - TVs 2) Intrapartum -> A So Prulation Urge defecate/Orthostatic to Hypotension. If ↳ Finding Medical M2 Confirm Ectopic Pry * => PA Abdominal distension a itfindingUnconfire Enam : Rebound tenderness mass Gaurding & Ridgidity ↳ king of five appearance 4 inside tube Only G Sac PvEnam : => : Soft Uteruy, Enlarged ↳ Empty Uterus. but less than POG ↓ sign Emm. 4Localizing sign ⑰ B-424 Estimation. ↳ Localizing Stabilize Vitals Mr : Doc - > Methotrinate ↳ ↳ UL salpingectomy Surgery preg. for dctopic 50mg/m2 IM Claprotomy/Laprosory) Surgery Salpinectory. :  Highest risk of ectopic pregnancy > - Previous 110 tubal Sn/Ectopic Pregnancy & Absolute Risk MK Risk for Ectopic : PID) salpingitis * Contraceptives : ↑ Relative Risk. #MOLAREGNANCY I0 > - Trs Standard - Gold > HPE [Proliferation of trophoblast ① Complete Mole ② Partial Mole (69XXY) Villi Present ; Hydropic degeneratiot ⑦ Paternal material > - 46XX > - Mer : Suction Evacuation F/B Sharp Curretage. > - No Jetal tissue ⑦ > - some fetal parts Pregnancy CI for 6 months of Uterus > POC POG > - Het > - Funda ht < > - ↑ BUCG level ( > 10 1/2) > - BUCG Higher:than Normal BIL thera luteal but less than > - cyst pregnancy mole App complete > - US9 : Snow Storm. > Less chance of Conversion to > - High chance of conversion - to GTN EIN ↳ou Storm app) #ntePartum Demorrhage : ① Placenta Previo ② ① : Abruptio Vasa Previe ③ Uterine Rupture Tz Pain Bleeding + No Pain in Abdomen - No pain Pain Tz Bleeding > - > - - + Red Coloured Blood Tz Bleeding Fetal Blood Loss > - Bright - + dif & Previous 40 C-Section Sinusodial Heart Pattern -> Uterus Relaxed , soft , + D/T PIU/PROM + on NST > + Bright Red Colour Blood Non-Tender Dark Red Colour > - > - Abdominal Tenderne D > - Fetal distress Ht. > - of Uterus > POG > - Uterus Tense + Tender - Parts Fetal palpable. - Fundal H+ > POY 102 - TVS > - Fetal part Felt Placenta Previa MoAbruptio Mr of ↳ Associations ↳ with ⑦ Continue Pregnancy and Johnson ① DIL if fetal distress Mcafer Regime ⑧ Preterm Labour ↳ C-section Termination ③ Couvelaive Uterus if fetal distrus absent & Retro placental Clot Q POGT34wKD : Induction of labour 6/b Vaginal del ② POG(34 wKs : Mr Like Placate Previe Toclisa  Hematological Changes in Pregnancy · Anemia - - Mr of IDA in T1 (Paventral iron (2) Hb < (i) 5gm/dL- > Blood Transfusion t Signs of CHF (ii) 2167 5gm/dt-2IFA/ day No signe of cuf in Mr of Anemia in El To Cardiac Changes Pregnancy 2) if Mb > 7 gm/dL > Blood 34 cbs ↳ Blood Tranfuss # To prevent Anemia for all Reproductive age groups : + Albendazol IIFA pill /week 2x a year * Supine Hypotension Syn # My2 Heart disease : MS ⑪ Mr of Peripartum Max Eisenmenger Sun Mortality Cardiomyopathy > Seen in - T3 * :. > - d/t Compression of IVC * M/C Congenital. - H D. ASA Ru left lateral pos Bromocriptive Program > - Lying : in is (1 in : + * Methyergometrine is (1] in > - Pulmonary MTN > - Marjan Syn ManageFalime Heart severe MS NYHA Grad 3/4 during Mr heart disease - > of Severe As Coarctation of Aorta Labour. > - = LVSE - >.  # Syphilip > - Follows Kassow if y law > - Not alw Recurrent Abortions # Varicella Zoster : weeky Taratogenic Period > 12-20 - * Congenital Varicella Syndrome Catarant Microcephaly + + Licatricial Skin + Limb Hypoplasia & Congenital Neonatal I # Congenital Rubella Heart disease + Cataract + SNHL + Blue Muffin Berry Rash - * Indication for MTP. dystocia #Shoulder ⑦ Turtle Sign McRobert's # Diabetes in Pregnancy : Gaskinin Diabetes ① PGDM ② Gestational 4 Maneuer * Priscillia White Classification. Controlled with diet > - Type A, - FBS7, 126 mg/dl Insulin Wood Cork Screw > - Type Az-Controlled by RBS Y, 200 mg/dL 2hr PP >, 200 mg/dL &: 1st 2 weeks : Diet Control HbAIC 716 5 % Weight Modification. - * Congenital Malformations in PGDM Not met - Iulish if goals + > - Risk Assesment tool : HbIAL insulin > - OHA if patient refuse ↳ IOC : TIFFA > - ONA ip 6/1 in PGDM * Rx of PGDM (Terminationoa C > - Terminate at 7 , 39wKD (A1) Algorith for Ra of diet Insulin (DOL) weight + not controled dystocia Shoulder - if themby 3a > - Counselling Low Dose Aspiri by insulin pertension in I Pregnancy # Magnesium Sulphate and DOL in preventing treatingSeizures hypertesive pregnant jemale in a. > - Acty on Receptor NMDA > - 4 - 7 meg/L * Pitchard Regimen * M/2Cause of Hydrops jetalips in T2 Jean is Turners Syndrome > - CIF of Hydroph Fetalis ↳ Scalp Edema (Earliest See in 159) · Polyhydramnios ) : Placentomgaly Tic Diamniotic One twin with oligo other twin with poly Ma : < 28 weeks in utero - laser ablation of passage 728 weeks : Amniocenter is twin of larger. Pre-Term labour Umbilical Normal Antery - Done at 22-24 cRp P/H Persistence in > - of diastolic Notch > Looks Most imp diameter during labour : Interistial diameter Obstetric : Area blo plane of least Outlet pelvic dimension & anatomical out let. # Pelvis Contracted : Contracted inlet : OC < 10 cm Contracted mid pelvis : Interistial dia [8em Contracted Outlet : Intertuberous dia