OBSETRICS AND GYNAECOLOGY

What are the basic signal function of emergency obstetrics and newborn care
 Administer of parenteral antibiotic (for puerperal sepsis)
 Administer of uterotonic drugs(for PPH)
 Administer of parenteral anticonvulsants(pre eclampsia/eclampsia)
 Manually remove the placenta (for PPH,puerperal sepsis)
 Remove retained product of conception( for abortion, obstetric haemorrhage)
 Perform assisted vaginal delivery ( for prolonged labour)
 Perform basic neonatal resuscitation(birth asphyxia)

What are the absolute indication of caesarean section

 Central placenta previa
 Contracted pelvis or CPD
 Pelvic mass causing obstruction (cervical or broad ligament fibroid)
 Advanced carcinoma of the cervix
 Vaginal obstruction (atresia,stenosis)

What are the intrapartum complication of caesarean section

 Extension of the uterine incision to one or both sides
 Uterine laceration at the lower uterine incision
 Bladder injury
 Gastrointestinal tract injury
 Ureteral injury
 Hemorrhage
 Morbid adherent placenta(placenta accrete)

What are the post operative complications

Immediate
 PPH
 Shock
 Anesthetic harzards e.g spine
 Infections
 Intestinal obstruction(paralytic ileus)
 Wound complications
 Secondary postpartum hemorrhage
Remote
 Gynecological
 Menstrual excess or irregularities
 Chronic pelvic pain or backache
General surgical
 Incision hernia
 Obstruction due to adhesions and bands
  Future pregnancy
 Scar rupture

What are the preoperative activities that must be done prior to caesarean section
 Written informed consent for the procedure,anaesthesia and possible blood transfusion
 Laboratory investigations
 Haemoglobin level
 Bleeding and clotting time
 Blood grouping and cross match
 Premedication
 Iv metronidazole 500mg stat
 Iv ceftriaxone 1gm stat or ampicillin 1gm stat
 Iv fluid either RL or NS 1.5-2L
 Catheterization
 Anaesthesia
 Either spinal, GA or epidural depending on the choice of the patient and urgency
of delivery
 Position of the patient
 Supine position with 15 degree tilt to the left
 Put on mask and cap
 Put on boots
 Scrub
 Put sterile gowns
 Put on sterile gloves

Mention five pathological causes of secondary amenorrhea

Uterine factors
 Tubercular endometritis
 Post radiation
 Surgical removal
Ovarian factors
 Polycystic ovarian syndrome
 Premature ovarian failure
 Sertoli Leydig cell tumor
Pituitary factors
 Pituitary adenoma
 Cushing syndrome
 Sheehan’s syndrome
Adrenal factors
 Adrenal tumor or hyperplasia
 Cushing
Thyroid factors
 Hypothyroid state

Outline 5 key steps in the active management of the third stage of labour for the prevention
of PPH.
 Uterotonic: Ensure that every woman is offered a
uterotonic immediately after the delivery of the baby. Oxytocin is the preferred drug to
prevent PPH.
 Delayed cord clamping: Delay clamping the cord.
for at least 1-3 minutes to reduce rates of infant anaemia.
 CCT (controlled cord traction): Perform CCT, if required.
 Postpartum vigilance: Immediately assess uterine tone to ensure a contracted uterus.
continue to check every 15 minutes for 2 hours. if there is uterine atony, perform fundal
massage and monitor more frequently.
 Oxytocin quality and supply: Ensure a continuous supply of high-quality oxytocin.
Maintain the cool chain for oxytocin and remember that potency is reduced if oxytocin is
exposed to heat for long periods.

What are the male factors for infertility

 Infections
 Gonorrhea, chlamydia may cause blockage of sperm passage, impairment
spermatogenesis, pyospermia
 Medical condition e.g diabetes, celiac disease, varicocele
 Trauma to the test e.g surgery, accidental injuries
 Occupation: high environmental temperature, working indoor
 Exposure to toxic substance e.g pesticides, farmer, food chain
 Drugs and substance abuse e.g alcohol, smoking
 Endocrine causes: hyperthyroidism
 Hematological causes: sickle cell anemia

What are the female factor for infertility

 Uterine factors
 Congenital causes e.g MRKH syndrome
 Acquired condition e.g endometritis, asherman syndrome

 Tubal factors
 Prior infection
 Previous tubal surgery
 Fallopian tube torsion and necrosis
 Ovarian factors
 PCOS(major cause)
Peritoneal factor
 PID
 Endometriosis
 Distorted adnexal anatomy
 Dysfunction oocyte development

A 25-year-old woman and her partner come to your office to discuss their trouble with
conceiving. They have been having unprotected intercourse for the past 2 years, but no
pregnancy has resulted. The patient is obese and says that she has "always been on the heavy
side." She describes having a period every 2-5 months and states that when she does
menstruate, the bleeding is very heavy. She has visible hair on her chin and upper lip, as well as
moderate acne on her forehead.
a. What most likely diagnosis?
b. What most cause of this couple diagnosis above?
c. How can you treat this couple?

a)The mostly likely diagnosis is infertility

Infertility is defined as a failure to conceive within one more or years of regular unprotected
Coitus thus the fact that couples have been having unprotected sexual intercourse for the past 2
years but no pregnancy has resulted warrants so possibility of infertility
b)the mostly likely cause of infertility is Polycystic ovarian syndrome do to the following
 Oligovulation
 Clinical features of hyperandrogenism
o Hirsutism
o Acne
Which fits Rotterdam criteria for diagnosing polycystic ovary syndrome

c)treatment focuses on the following

 Inducing ovulation
 Weight reduction
 Managing hirsutism
 Management metabolic syndrome
 Prevention of endometrial hyperplasia

Inducing ovulation: If the couple is trying to get pregnant, medications like clomiphene citrate
or letrozole may be prescribed to stimulate ovulation.

Weight Management: Since the patient is obese, weight loss through diet and exercise is often
recommended. This can help improve insulin sensitivity and regulate menstrual cycles.
Hirsutism: antiandrogen like cryproterone acetate,spironolactone,flutamide

Metabolic syndrome: metformin is used for hyperinsulinemia also patient may benefit from
metformin rather than other drugs since it also facilitate weight reduction

You assisted in an elective Caesarean section of a primigravid woman with breech presentation
at term, without any obvious complications. Three hours following delivery, patient complained
of severe perineal and abdominal pain, On examination, patient looked pale, pulse rate -92/min,
blood pressure 100/60 of Hg, uterus well contracted just above the level of umbilicus and the
incision site was otherwise normal. Urgent trans abdominal ultrasonography was done which
showed a hypoechoic mass on the right side with a well contracted uterus. Broad ligament
hematoma was confirmed. Using your understanding of female pelvic anatomy,

a)describe the arterial blood supply of the uterus

b)state the artery that was most likely involved in this condition.

Arterial blood supply of the uterus

The arterial supply is from the uterine artery—one on each side. The artery arises directly from
the anterior division of the internal iliac or in common with superior vesical artery. The other
sources are ovarian and vaginal arteries to which the uterine arteries anastomose. The uterine
artery crosses the ureter anteriorly about 1.5 cm away at the level of internal os before it
ascends up along the lateral border of the uterus in between the leaves of broad ligament.

Uterine artery gives off several branches that supply different regions of the uterus, including
the myometrium and endometrium. One of the branches of the uterine artery, known as the
ascending branch, runs in the broad ligament and can be at risk for injury during a caesarean
section.

b)the mostly likely involved artery in this condition is uterine artery(ascending branch)

write short notes on periodic abstinence as a method of family planning focus on definition,
method used, advantages, and disadvantages.

Periodic abstinence is a family planning approach that involves tracking a woman's menstrual
cycle to identify fertile and non-fertile days. Couples use this information to abstain from sexual
intercourse or use barrier methods (like condoms) during the fertile period to prevent
pregnancy.

Method Used:
Tracking Menstrual Cycle: Women monitor their menstrual cycles by recording the start and
end dates of their periods on a calendar.
Basal Body Temperature (BBT): Measuring the body's resting temperature every morning
before getting out of bed. A rise in temperature indicates ovulation has occurred.
Cervical Mucus: Observing changes in the cervical mucus throughout the cycle. Fertile mucus is
clear, stretchy, and slippery.
Calendar-Based Methods: Predicting fertile days based on the length of past cycles (calendar
method) or counting days from the start of menstruation (standard days method).
Ovulation Predictor Kits: Using commercial kits to detect the surge in luteinizing hormone (LH)
that precedes ovulation.

Advantages

No Hormonal or Medical Interventions: Periodic abstinence doesn't involve hormones or

medical devices, making it a natural and non-invasive method.
No Side Effects: Since there are no hormonal contraceptives involved, there are no associated
side effects.
Cultural and Religious Acceptance: It is acceptable in cultures and religions that prohibit or
discourage other forms of contraception.
Increased Awareness of Body: Women become more attuned to their menstrual cycles and
reproductive health, which can be beneficial for overall well-being.

Disadvantages

Effectiveness: Periodic abstinence requires a high level of commitment, knowledge, and self-
discipline. It is less effective than many other contraceptive methods when not used correctly.
Limited Protection Against STIs: Unlike barrier methods like condoms, periodic abstinence does
not provide protection against sexually transmitted infections (STIs).
Abstinence Required: Couples must abstain from sexual intercourse or use alternative methods
during the fertile period, which can be challenging for some.
Cycle Irregularities: Irregular menstrual cycles or health conditions affecting fertility can make
this method less reliable.
Learning Curve: It can take time for couples to become proficient in tracking fertility signs
accurately, increasing the risk of unintended pregnancy in the initial stages.

Write short notes about postpartum fever focusing on definition and causes of postpartum
fever.

Postpartum fever is defined as temperature higher than 38 degrees on two occasion at least 4
hours apart after the first 24hrs postpartum and during the first 42 days postpartum

Classification
 Physiological puerperal pyrexia
  Pathological puerperal pyrexia
Physiological pyrexia
Rise of temperature that doesn’t exceed 38 degree and drops within after childbirth and 3 rd to
5th day after child birth
Pathological pyrexia
rise of the temperature higher than 38 degree on two occasions atleast 4 hours apter after
24hrs to 42 days postpartum

Causes of postpartum fever

a)genital tract infection
 Endometrium
b)extragenital tract infection
 Breast
 Urinary tract system
 Superficial thrombophlebitis
 Respiratory system
 Septicemia

Mention five treatment option in assisted reproductive technology

 Intrauterine insemination (for oligospermia and asthenospermia)
 Invitro fertilization with intracytoplasmic sperm injection
 Zygote intrafallopian transfer
 Tubal embryonal transfer zone
 Subzonal insemination
 Assisted hatching
 In vitro maturation of oocyte
 Preimplantation genetic diagnosis
 Gamete intrafallopian transfer