a) I -11%1 me .

C. not pregnant Jog ¥-4 / chief complaint die

☒ Lower abdominal pain Its most command c-

→
Gynecological causes gynecological
non -

causes

( non pregnant )
-
( non -

pregnant)
① ovarian cyst ↳ 2.5cm ) ④ Appendicitis
_Ñ 22.5cm Uli !A

follicle .

② Cystitis :
inflammation of
@ Its 2.5cm ?,a→ urinary bladder usually caused by
>
,

◦
paint infection of urinary bladder .
② Torsion of the ovary or ⑧ urteric stones : stones
torsion of the cyst .

migrate to the ureter .

&, twisted ststsiovazsl - ☆ Lower abdominal pain in

,
pregnancy :

1¥46 µ ! :@ M Ligaments I
Early pregnancy :

ovary ~ blood supply It E- &

congestion-4,6 fallopian tubes-1 , ① hen pregnant I / If ¥S_
-

My blood Iris's % cyst 11%0 ..W1µÉx @

* Hi IKE.ph#tByosa1pinXiCystitis/SalpingitisyUTI) infection
•
vessels such

congested large ovary g. ⇐ appendicitis As 0 stones stg

9.Torsion IN !Ñi :& ② Ectopic pregnancy .

-
severe pain
 - severe tender rigid abdomen on ③ molar pregnancy
•

palpation .

④ fibroid
•

- on v15 →
vaginal scan

Iwo flow Dj's

] ⑥ cancer in last stages .

Mg if# ↳ flowD cut I ← !

*
congested large ovary i ! ⑦ Abortion
Cid ovary
JI EH *sb -
_

s-emmyidiameterw.gs second trimester

pregnancy
:
⇐ 22k¥)

diameter Ai ! I # % second trimester abortion

&
'

-
Sl II *

btorsion If 1¥ 6 5cm I ◦
painless A- is

ji ~ ↳ laparoscope so
: second trimesters # Pains ← Wai ⇐

⇐HI I -1M¥ / ↳ %
.

.
?⃝
 ③ Rupture ovarian
cyst @ non gynecological cause , hydro nephrosis
bfollicnlar cyst U stg

sis oblations uterus9166 18-20

-

.- F- I so @ 6

hemorrhagic gio luteal cyst rupture t.im#b abdominal organ #

cyst

gEBureteBJ1bcompression@s9.h
emorrhagiccsstldd.ua Aight SINAI ¥ 6 ureter
• luteal cysts # ¥ ~ #0 Right hydro nephrosis .IM
ultrasounds into is *

£-7 simple cysts lutealgsts.IE is -3¥ Flank pain dysuria

,

two homogenous ] hypoechoic :@ • clear •

costovertebralangl@J.j
:& # hemorrhagic S1H6(density t

ohypirechoic@ ↳ hypoechoic o
particles
shadow shadow
•
-6¥, #

ÉÑ hemorrhagic cyst A *
I:@ Huta / gsts.ME Is pain I 1b¥ :b ☆

corpus lnteumsliso ovulation At uterus I. Ñb d) It IN # ↳

A. vesselsAbs is vessels & $ # 4£50 radiated pain#
1- ↳ oozing IMM
bcystsl Collection of blood •

kidney percussion I =L - ←

a.
hemorrhagic cyst Eid

↳ £1 most common
cyst It *

Rupture of luteal cyst §

*
I -1 iW ÷
'
•
hemorrhagic cyst D %

•
Rapture Kr .
necrosis of capsuled 1$

Indirect percussion Direct percussion

 ④ pyosalpin ✗ E.
fallopian tubes
fills up and swells with pus .

tubes # ohydrosalpinxs HI pH
b. tube ✗ § fluid spy ..M.
block
£1m
-Ñ6pus A infections fluid JI 8h ! is

•
pyo salpinx
PID {↳ HIII Fife ☆ .

( Petrie inflammatory disease %} / 2dg percussion St ↳ 15 :*

↳ stretch ↳ # His 6*1
myo metritis ~ •

↳ endometritis ← if
6
Capsule of kidney I
↳ para metritis
÷ G. severe infection -61 :& kidney -
*I ←
tag II
to
accumulation of pus , infected tubes renal disease .

•
pyo salpinx ,µ
A specific } -6 examination Iq
?⃝
⑤ Fibroid → most commonly subsérosal If # Right 16¥
sub mucosal ✗ ↳ •
pain Slim £1K I
growing I#
_& uterus JI

bleeding EM .
É) fi right Std deviation
dextrorotation of the uterus
•

9. &,
-96 degeneration subserosawo-M.it#-h.dfFpxgnanyE4
,
necrosis finis
weeks
•

huge V1 : !

@ preterm labor pain or term laborpain .

⑥ Endometriosis : second most common came

of pain . ②Abruption placenta

# Pain Sho chocolate cyst e-
¥6
c-%f1~I~ksomensesslp-i.gs
~

cyclic ③ Uterine rupture →

ectopic pregnancy
mj-wk~ssdgspareaniq-j.im Gcornual pregnancy I # Ud

(involved It organ St .-) Dyscheziq cavity WINS.BA

rudimentary
•

≤↳
horn of the uterus
 Second trimester
¥7B
*7①Im perforated ↳ men : ɱñs* My :b At

£1 ultrasoundSI SEIM •
Rupture I-M.sk#bzd1
II. • tiematometr: a im
• Collection of blood in uterine
cavity * Catastrophic ~ # so _

shocked#g internal bleeding

t.F.CI#afi
ix. ! WI
-

minor
surgery & ⇐ • =

crescent incision

•
story si ectomj %
④ The second most common chief complaint is
bleeding .

☆ Not pregnant :
period or menstrual disorders :
metrorrhagia , menorrhagia ,

Meno
metrorrhagia .

② polyps, ulcers, or erosions in cervix → minimal

bleeding
\ ? Ii -411 LEG & - o . .. . _

poly ptsi erosions I ÷ -

sexually active Ii :S postcoital

bleeding
↳ - ←
? -4¥ ⇐
 ☆ pregnant woman 8

@ Abortion

② ectopic
pregnancy
③ molar
pregnancy →
profuse bleeding ± :& %E;
advanced
IV. % 6 iii. I # -11 'd
-

6 -
p z.
← ,

if 67mi -Ñ'M , I ← im g , FA second trimester Sis

•
myometrium JI invasion b↳ # -6 @ :} bleeding I
I
t.
& -71dk
~

Atony
≥ G- → ←
÷_ It @ vessels %
.

Hysterectomy
 Advanced gestational age
:

@ Abruption placenta

② placenta previa ( painless) •

1¥ bleeding it, placentpneoia # ↳ bar

.
- iii. 11 1? ~, ? bleeding @ 6mF Ii b- -

:&
.

• Adherent @ -16 £1 placenta 1

⇐* bleeding Sjoincreta Dg percreta I accrete
nay
myornetriumsl -
separation % placenta SI is ! prognosis
invasion be WI
bleeding _&⇐Ñ%Ñ→
lit
.
o invasion @ ↳
Bad sign _Ñ
③ Vasa pre via

¥!ᵗ÷÷÷ÉiÉ
•

Atrophy 136am most common cause of bleeding St ←

☒ Vaginal discharge :( early pregnancy or not married)

= .

physiological pathological
-

watery - infection [ Bacterial vaginosis , Candida ]

↓ ↓
- odorless
-
green -
Light Yellow
-
Colorless -
Yellow _
thick
↓ -
cheese like
-

antibiotic
antifungal
Glands

IWKsDvaginaS1@leftSsopostorior1yg.s
•

Wil
's parthdin 's glands glands *

opening of vaginal Rights

 bparaiurethral glands 's # spy Skene 's Glands SI I *

urethra and left

ix. • Éñ 1.5 -
2cm if • d-
Right →

intercourse 'd lubrication is -6,6 urethral A Lubrication

Vagina during opening

Ñ Nabothian GlandsIt I -6 &

◦ mucus
jim , cervixA
lining .

physiological discharge y µ Glands St Job ←

• 7 -10cm - WH vagina SIR

Vagina D Lubrication > is 6 Glands j@wvaginqSi.W - *

1%-6 Ñ vaginal walls -611m¥ intercourse JI JI

G- Ñ vessels ✗ ← ↳ 6 vessels II I & Sub mucosal ⇐

vessel I # plasma D
Cz # 7 Transudation His plasma
wall

sina.ne-sea.at?::i:::::::;:::..-I-..
① amniotic fluid leakage ( Mup tune membrane] .

É•↳ Al -
INI ≤ 6¥ discharge ← i :b ↳ -

↳ Liquor Jim
.

←•j 6 amniotic fluid leakage ? Sim

 Liquors @→ pooling It ! If ,
speculum % it # 1-

② Urinary incontinence nce : heaviness I ✗ ← ! ..ñ

(stressincontinenance)•Compression&,6guterusg
to term amniotic fluid II Jj lil
.
:
¥462s -

19¥11 qi-o%df.mil so

leakage ✗ 1:16 lung maturity I @ amniotic fluids

%bc-isd.ec ! 90% risk - I @
6¥# I t.MG# fluids
0

(Talipes
( clubfoot)
← → HIGH AM
-¥% yµ,%h ←i ) birth defects
 • ( No lungs ) lung hypoplasia ? If.tl#-k ②

÷ / sis's infection A High risk ¥ ③

-
severe infections .im septic shock Ii it ↳ ④

☒ loss of fetal movement :

@ missed abortion or IUFD

② oligohydraminosorpo-yhydro.tn?&d-#.--I:
Large abdomen ?
③ fetal distress or IUGR .

④ hypo perfusion to the placenta →

signs of fetal marts:D
;ty
⑤ Syndromes ( down syndrome/ or syndrome relatedto Cws )
Hypotonia im ]

④ size of abdomen :

small Large
-
IVFD -
Macrosomiq
-

Oligohydraminos -

pdghydraminos
-
IUGR -
Multiplegestation
Multi
Retardation parity
_

T.io#d&jqouternsXis
-
→

thx
Fibroid
-

-
 ⑤ Edema : Facial edema ,
lowerlimb edema, generalized edema ,

Peri orbital edema .

Edema in
pregnancy
- -
physiological pathological
-

plasma increased by 50% -

PET → activation -M.

lower limbs 1%5=-4141
edema St
'

Renin Sid 6 RAAS A

increased hydrostatic pressure £04 > vasoconstriction .at .

uterus JIM compassion 1 .ñJ this .to Hypertension

bintravaseularsl I pressured # vessels SIK damage of the vessel if
vein JIM return of blood Stds endothelium .

pressukt-sfj.ge#s1&1- ⇐ i permiabili-tgSHI.es -
6
J-iw.perrmiabilityJ.si
vessels ¥ , general vesselHI
# &¥ Fluid 11 -Ñ organs I -5W
vessels si

fluidI extra accumulations-9 •

kidneys Liver lossless /
-

vessels
extravascular is interstitial spaces # ÷# a kidney II is
• edema J-ia-I.S.ws loss of protein
• intravascular Sl

( marine %
extravasation -M. For
intravascular / M fluid D

_.I fluid 1) interstitial'd

oncotic pressured ~
-6
j.tl
- bit interstitials #
◦ intravascular /
 @ 6 live.ir JI } &

im Wessels A damage SI

I _.KC Vasoconstriction
)I

two hepatocytes
'
A
hypoxia
synthesis of proteins SI
and album :* .

• edema # YA

brain 1%9
¥56
6 headache ¥11
& -

☒
,# ←
t.it
② @
Ñnstri- pressured
_③edemaT
6
_

↳ vessels Dm fluids /
brain tissue 1
'

-2¥ ⑥
 ↳ ⇐ EH
Gblurredl vision ,

b compression-6 dis

• optic nerves /

6
epigastric pain *

stredhg.SI
capsuled
-
-1g 1. ↳ ↳

rupture I vessels
-4.6 vasoconstriction / @
sub
capsular hematoma
or sub hepatic hematoma

pain Jim
◦
⑥ Leg pain :

phlebitis Cinf lamination of therein ]

-
Varicose vein

-
DVT
11mg
- muscle cramps [ Commonly in
pregnancy
due to hgpomagnesemia

☒ Back pain :

compression on sciatic nerve

 ~ laÉÉy1s epidural d-
% ! U
⇐ ⇐

em! relax.in hormones / 121 ~→d~↳ progesterone I £1s

sciatic nerve Ab compression je spine A

hyperextension
g

•
Sciatica Isa pain t

emesis,
vomiting
party
:
physical examination