P a g e | 1

" ! " # $ % &' "

" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
. 1
/
0
4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
D )D E
2( ) F9 GHE IHJ )- KL ()*
(- ! * M ()*

@L
@C " N &D K O PQ R S5(D T) '2
; U &R5 # VH! O NB W N &D KL O N
X )Y GZ O 8 I# * O &)- [H\" $ E
] 2 2( 2% U^L _*. U.@? `
O ;% #" 2( .a5 O PN &- O P
. O PQ &- O P T) 2 I\b 2%
)QL C 2(
! (56 $ V(*) c 28 $ L(J) c ;Q d*$ c
V(*) 0D H\ d* $
'~= =
~= ~
. mast cell '-= = -- glycogen
~ + ~= =' '+ ~ . MCQ
'+'
=-

- . constituve insulin response
. pancreaetic reaction - - '~=
- ~
= = '-
P a g e | 2
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
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7
8
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. 1
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"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
= ~ - '-~= ~
'= ==
- ~-- ==

= -~ - ~' ~ ==
-~ _-' - == ~- =
~=
.' - '-
'- ' -~

`-- =--= ' `= ~=

' ~

'= ~= ~= '= =+-- ~= -=
=
-= ~= ~- `
.- ~= '
='= ~= '+~ . placenta
' - ~=
. placenta ~- ~= ~- = '= ~-
P a g e | 3
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
. 1
/
0
4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
- - '~ ' '+~ placental insulin
- ' '
' placenta
- ~=

'~= ~ =~ '
'~= = '= ~=' '~= '=
-= -- ' placenta ~- `
. ='= - ~= -'- -
-'- =-~ -=
- ~ human placenta lactogen ~ - -'
~- + ~= '
Anti insulin
'= -'+ . placentA '+- -' A!" "#$%"
&'(M')#
~= *AC!'( -= ~ ~ "#$%"A#)
'~ ~= ~ - -'+
_'- -'+ ~ ~ . "#$%"A#)
~ = ~= .~ ~
=
P a g e | +
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
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7
8
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. 1
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4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
,&A! "# !&) MA" M)C&A"#M '+ ~
- ' -~ -'+ . P%AC)!A '+- '-
= -= ='= ~
. P%AC)!A% "#$%"A#)
-= -'+
~ '
-= - ' ~ '
~ - - _-
-= - =~--
=~- = = ='= '+~ D"**$#"'

-- ~= = = . '#M'%A("!- - ~= ~ -
'= ~=
~ ~= =
-' - ' + ~= ' ~= '++~ '=

- -- ' ' = - '~ ~= ~ = =~
' .'~- = . CA((")( P('!)" '-' D"**$#"'
'- C'C)!(A!"' G(AD")!
- ' ~ = ~
-=
P a g e | .
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
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/
. 1
/
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4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
= ~ -
~ '+~
"C()A#)D G%$C'#) !'%)(AC)
-= -~+ '+
= G%-C'G)
-= '-
-= "MPA"()D G%$C'#) !'%)()C)
-= -=
'~= = ~ -

'~= -= ~= ~ - . C'C)!(A!"' G(AD")!
-= -= ' -~
~ ~= ~ '-
-'- ~ ~ . +-'= ~ '+~
GA#!"!"'A% D"A/)!")#

'~=
-'= ~ '
. GA#!"!"'A% D"A/)!")# '+'
APP)A( '%- " !&) #)C'D &A%* '* P()GAC-
P a g e | 0
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
. 1
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4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
= '+ '- '-
-= '- ' -~
- . #C())"G - ' . 24 - 28 ,))1#

-= -'- ' -~
-'- -~= GA#!"!"'A% D"A/)!")# - C*M

Congenital 2etal mal2ormation

` ~ ' -'- -= += ~
-= +'= ~ ' + -= '~ ~
= = enumerate clinical and 2etal mal2ormations
-= = .~
Discuss complication o2 DM
discuss '-'
_~
'~ . ='= .' de3nition
~= - ~
Disorder o2 C&' meta4olism 5ith a6ection o2 lipid and
protein meta4olism
Due to partial or a4solute a4sence o2 insulin
A2ter ' -~
P a g e | 7
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
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"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
A2ter C&' load
~- _= ' -
~ ' ' ~
'~= ~ - '-= ~
Postprandial
postprandial
~
'= -- =~ ~ ~= ~ ~ -~~ = ' ~= ~
-= ~ ~ = = ~ ='~ ~ -='~
=' '= -'
'~= ~ '-= ~ =' `=
~ '-= --
~ ~ =~ = . etiology =' ~ --' - '+
= = - - . complication
- '= - ~ ~=
Complication =
complication =
-'= =- -' ~=' -- . complication =

efghijekljfm
P a g e | 8
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
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7
8
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/
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94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
~ .~ . heart disease '- -- '~ = '~
=
-= - ' .
Discuss
' management
.- - -- management ' ~
~= ='
- =-- '= '-~= ~ - '- =--- '= '-~= ~
` _` ~= -='=
. ='=
nmopijm lqrskht
'+=~ .= ' '~= =- ~ -- '
'
'- ='= ~= =- . complication ~= ~= +-
. -- ~ =`= ~ -= ~ =`= ~ ~-
-= - .~ ~ =
=
` ~ '= - =' -'=- '+= .~ ~
. .' de3nition ` =~ ~ ~ = . etiology
'-~ . complication ~ -
-= .' management '+ -=
P a g e | 9
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
. 1
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4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
-=
-= '- according
` '- ' -
= = . complication
-= ~=
- ' -~ -'- ~= +'
Dia4eitogenic
-= especially -
'-
~ ~
"mpaired glucose tolerance
-= ~ -
'~= . anti insulin hormones +- . placenta '= - ~
~ placenta insulinase
-= ~ . ~ = = = -'- += ~ ' ) '~ -
==' (
~
~ '- 5orse '

-' ~' = oral hypoglycemic ~-- =

P a g e | 1:
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
. 1
/
0
4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
-' ~' = == ~-- == -' controlled
-- uncontrolled
'~ . 2ate ~= - ~~
= ~ -'-
= -'= - control
' -~ ~ ' ~= - '+~-
=- ='=
-'= - ' '-~ = '- ~ -= '+~-
'+`-- _~- '+=

+ -= += hypoglycemia
~ ~
- -= ~ -'` -'` -~ ~ -~
-=
- ~ ~= '+~ glucosuria
-' ' ~= =

~- '+ ' '' -~ ' ='= -- . 5aste product o2

meta4olism -='- - -'= ' =
- ~-
. (/* . renal 4lood ;o5 .~ 50 %
P a g e | 11
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
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/
0
4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
~- ~=
. G*(
- ' - ~= ~- .- ~= '+

' ~= . threshould _'-

180
~= ' 140 - 130
~ = . -~= + . urine
~ ~ renal glucosuria
~ '
~ ' = '-~ - screening ~= '= . urine

= `-- '-~= glucosuria

. renal 4lood ;o5 ~ .~ 50 . % glucose threshould
130
~ ~ ' ~= ~ '- '+~ elementary glucosuria

-' . ' '' ' '= - . 5aste product . ' '
'' ' '=
- '' - -'= ' =
P a g e | 12
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
. 1
/
0
4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
. 4lood ;o5 G"! ~ - '-- ~ = =
assimilation ) ~ (
Assimilation o2 glucose response = '= .= ~
-~- ~= - - G*( 130
. urine
~ '+~ elementary glucosuria - ~ '+= -=
hypoglycemia
=' -'- -~= nusea < vomiting
' =- '+- starvation ~ -
' ='=
. placenta -'` ~ '= ~ ' '= =~ ~ ' '=
=~ ~ ' '= =~ ~ - ~='- =~- - '+=-
-' ~
- ' ='= - ~ -=

- ' -'=
~ '+~ ' -~
~= 4 -'='= =~ hypoglycemia
-' -'= =-- '=
' - -- =-
P a g e | 13
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
. 1
/
0
4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
-'` -~

- -'` -~ .'~ ~=
. uterus
-= .= -' .'~ .'=
'=
~ '+=

-= ' '~ == `' =
=~= -~ =~ = -~ - == '-~- '+-
-- '=
-~ ~ -'-' = -'= =~ '+ -- ,~= '+=~-
hypoglycemia =
-- ''-
~ -~ = - -= '~
. placenta -' ~= -' `= '~ .= -- '+'
- -'` -~
+ ~ -' = ~ -' ~ ~ . placenta ' - -=

'+= hypoglycemia
-'`' -~ ~ ~ -='-= ~='- ~ -'` -- ~
P a g e | 1+
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
. 1
/
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4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
= ' - -'`
5orse ' ' poorly controlled
During pregnancy
During la4or
A2ter la4or
-= '-
=
~ '+ 3 ='
= =
= =
= = . neo4orn
'= '+ in2ant o2 dia4etic mother
-= ` ~-
'- '+
=
-'` -~
~ -~
= =
~ -'='= '+ - . p
Preeclampsia to=emia ~ ~ '+- . 25 %
P a g e | 1.
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

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94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======

'~= . vasculopathy
-= `'- = . 4lood vessels '-~= ~ ' -
'= '-~= ' ' . gastitional dia4etis - -=
'-~=
=' '- '+ ~-- - . p - . polyhydraminous
~ 25 %
-= _~= 6 -'~ ~' - ~
'~= =--= '-~= ~ ~ ' ' ~ - - -- '
'
- ='= '+~ osmolar load ' =~ ~= ='= '+~
polyuria
' ~ -= . congenital mal2ormations -+~
~= . C#* _-' = _'~
. pituitary gland ~= ~= ='= '+~ AD&
. 4a4y control = . G"! .~ ~= ~ 3 -'~
~ ' ~= 3 -'~ - + -~ 3 -'~ '-
-'- ='= ~= '+~
Placenta previa '+~ ~=
-='- -= ~
-='-
P a g e | 10
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
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4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
delay disappearance o2 >ona pellucida
. 4esalis ~ -='- ~ - -'= '- '- ~ -'=
-= =~ . placenta previa
' ' -~ - ~ -= . antepartum hemorrhage -~ ' -
placenta previa - accidentaly
-= placenta previa '-' - '-
~ accidentaly - sudden drop o2 placenta
-= '
"mmunocomprmised '+ ~ -= +- in2ection `
-''+- . vagina
-= ' -~ '+- -''+- . vagina
.' . ~ -~-- ~= `- ~= ='-
. candida al4icans
- --
= =
-= ~= '-
`- . pyelonephritis
`- - ' -'= -=~ - -''+- ~
-'= '+-='~ ~='-- + _
(egular =
~'
P a g e | 17
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

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4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
- ~ '-~= acutepyelonephrities
'+'
$nder stress
~' - ~ '+~
(egular insulin
~= ~= -= distress ~ ~='
(egular insulin short acting insulin
~ ~ = la4or
~ - .' p
Prolonged
Premature rupture o2 mem4rane
~= ~ '= . uterus
'= distention ' atony
-= ' ~ -'= engagement
-'= engagement -'=
~' = . cervi= .~~- ,~
. amniotic mem4rane
-= ~ -~ ' -~
'- -- ~ -'='= ~-- - . s
#econdary involution
P a g e | 18
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
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7
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4
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4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
#epsis
secondary postpartum hemorrhage
= . hemorrhage< sepsis .~ +~ -~ ,~= ~ -~
,~= '- ' macrosomic 4a4y - shoulder dystortia
'-' - truma
' - D"C - hemorrhage ~ '- . in2ection '
- +~ in2ection -- '-
#taph . strept
'= . strept '-' '- - pur4epral spsis
'- ,~= =
Di6use types
%ocali>ed type
= =' - + =
'= - .- . di6use type
==

. di6use type '+ ' - ~~ =' =+
. locali>ed type ~ sever - . sepsis --
-'~' ,~ -= spread ~
~ '-= = = . 2etus
P a g e | 19
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
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7
8
4

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4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
'- `-- ='= ~= ~= ='
Congenital 2etal mal2ormation ~--
3 -
-= - -~ 3 - - '+='-
2-3 % '- -- 6 - 9 %
' -~ 2 % -~ ~
minor not inter2ere 5ith li2e
3 = . ma?or congenital mal2ormation
1 - ma?or inter2erence 5ith li2e
2 - ma?or dys2unction . do5n syndrome
3 - need ma?or surgery as coarctation o2 the aorta
-= ~ -'-~- ' -~' ~=
C@# - . @#D . transposition o2 great vessels
~ ~= -'-~- '-
-'-~- . C#
' . caudal adhesion syndrome
- . caudal `= -~ -
' ~ -'-~- ~= 3 -'- ~- = ~= 3 -'-
-= - . normal ~=
10-20 % . a4ortion -~
P a g e | 2:
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
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7
8
4

/
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0
4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
-= '- ~ -= =
'= . ~ ~
~=
=- hypo=ic in?ury - =- . vasculopathy
' = ~= ' -~= ~ = +
Glycosilation o2 2etal protein
~ ~ + ~=
. vasculopathy
Glycosilation o2 protein
-= ' -~ ~ ~= -'~ -'-~- - - -'~ . a4ortion
.'- ~= ~ - ~= . ~
` ~ - = ' -~= ~ ` ~ - '

. gastitional dia4etis
-= - -= - '-~= ~ - '-~= =~ -'-~-
'+~
=-- ~' '+~ insuline
'- ~ ~= "G$(
-~ '- . "G$( -- '+= 20 = % ' . macrosomia --
'+=
40 %
P a g e | 21
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
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7
8
4

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4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
_- - ~= - - . macrosomia
= '= ~ =~- ~
~- ~ =~
'
'~= ~- ~=

- ~ ~=
' - ~
- - . placenta -- ~
- -- ~ ~ '~
-= - ~= _-
-~-- ~= -'= . shoulder
~ -'= ~ -'-
=- '+ increased glucose meta4olites -'-
=- ~ '- - -=
- -'- . normal
12.5 ~
-= ~ . macrosomia -- . gastitional dia4etis
~= -'- ~- 90 + % gastitional dia4etis ~ =
-~= macrosomia ' = polyhydominous
P a g e | 22
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
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94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
'~ . gastitional dia4etis
. "G$( -'-~- . a4ortion =- . vasculopathy
=- . placenta insuAciency
'~ '- ~=
Preterm la4or
' ~= = distended '' -- = ~ ~
- ~ `-
~ ~=
- `- ~ ~=
/2 agonist '+~ -'== '+~- ~= -= ~ '+~- -'

'+~ '+ -~- = ~
'+~- ' =
-
"n2usion drip ~- ~ = -~ -=- ~= ' ~- -
-~ = . /2 = . /1 - ~=
. liver
&eart
Pancrease
~ _ +~- ' '-~= '~ -
_ +~- ' '-~= '~ . liver
P a g e | 23
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
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7
8
4

/
. 1
/
0
4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
_ +~- ' '-~= DM '+ `'-- = '
-- - .' ~
=- `~' '-' =~= 3 ~ '-
~= CBCB/
Prostaglandine inhe4itor
~= ='= '+~ magnesium sulphate
~ ~ ' ='= -`- .~
-= ~= pyelonephrities ~ magnesium sulphate


- ~= = = -'~ ='- ~= = =
-= --' =~= . steroids '+~
. steroids ~- ' =- ' ' ~
-= = ='= ~= - "*$D
-
'= - - = -~
- - ~ '= -=~ D1A ' -~ '
- = -~ - une=plained "*$D
~ - - '+ ~ -~` - ~ '-~ _~
- -'
P a g e | 2+
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
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7
8
4

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4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
-= -~' '-~-- vaginal ceserian
#ure ceserian
--- ~- '+ ' -- ='= ~ vaginal
delivary
= ~ ' ~= -='= = ' ~ ~- ceserian ~ -~
. macrosomia
'- ='= . une=plained "*$D
-= '- -~ . in2ant '=
~ .~ ~= ~ = =
Discuss in2ant o2 dia4etic mother
~ .~ .'=
~= =' _+ ='- 4 -~ .'= ' =~ +
.~ ~ discuss neonatal ?aundice
.~ ~ discuss (D#
.~ ~ asphe=ia neonatorum
= .~ '' in2ant o2 dia4etic mother
-= -'=' ~ =- ' -~
= 8 ~ ~ ~-
` '
"n2ant o2 dia4etic mother -
P a g e | 2.
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
. 1
/
0
4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
=~= -'='= - -'='= .- -'='= =- '+= +~
~= -= . hypo=ia

~= '- preterm la4or ' ~- ~ = (D#
-= '= . in2ant o2 dia4etic mother ~= hypo=ia -
~= '= = .'~
. pancrease
~- ~ ,-
- `- ~- . corticosteroids
.' sur2actant ='- ='- `- = hypo=ia
-= '-
&ypoglycemia
~ '= ~= - -~ ' =- - ' '=

~ ~ ~' '
.'~

+
-' ~ ~= ~ ~-
~
P a g e | 20
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
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7
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4

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4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
'~= ~ '-~= DM ~-
~-
= ~ - =' =
Percussion o2 DM mother '= ~-
~- ~-
. prepartum -~ -'
' ~- shoulder dystortia
' ~- ruprue uterus _'- . macrosomic 4a4y
_ _
-= '-
`- ~= hypocalcemia

~= 2unctional hypoparathyrodism
-= ' -~ ~
. (/Cs
`-- ~= polycythemia

- = ' ~= hypo=ia
`- erythroprotein - ~ ~= ~~= . (/Cs
P a g e | 27
" ! " # $ % &' "
" ()* $ +( &' ,, #" -. "
/
0
1
2 3(
4
56
7
8
4

/
. 1
/
0
4
94 : 7
4
"
Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
. ' . ~ ~ - - . (/Cs ~ '+' -- - '
4iliru4in
- ~ = '
= . - -'` . (/Cs ' -- -
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-=
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. 4iliru4in = . 4iliru4in -' ~
-= . 3 -'='= '-
. ='= ~= truma +~ truma ~= - . shoulder dystortia
~ _`= ~= shoulder dystortia
Cust call 2or head
P a g e | 28
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/
0
1
2 3(
4
56
7
8
4

/
. 1
/
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94 : 7
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Gynacology Dr- Mandouh ;< ====== > ?@) A5B.
C68 ======
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"nvestigations
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"nvestigation 2or diagnosis
"nvestigation 2or complications
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