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These pages are kept empty purposefully for Index
make your own index while studying to speed up a
simplify your revision

INDEX

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Physiologyagamenstration and applied anatomy
uterus
multiparous women 8 10cm

19hPM nulliparoces
cervix length
women 7 8 am
4cm

HEEEvagina Shoot cervix C2 em

fm
halva External Os

g
a

labia S
labiaminora
circular transverse

_w
multiparous multiparous

ala
Fallopian tube
7 to 121m Isthmus Intramural past

Isthmus Narrowest part of tube

111 ectopic preg
of
Intramural past narrowest overall

Ampulla widest
4 fertilisation occurs here also the me site of ectopicpreg
tot
Mc rupture in Ectopic

Fimbria t clasp
congest strand fimbria ovarica

ciliary action 4 tubal peristaltic moves the oocyte

in the fallopian tube

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ciliated columnar

Miffy
Epithelium

i M

Anatomial Int Os

hiÉÉd
Histological Int Os
and waited sq.epiineu.am
ummm
Ungava fm
squamo columnarjunction g
sq Epithelium
transformation zone

_w
place I had rapid dividing cells

ala
6 seen in all age groups women
of
6 located 1.7 to 2.3cm from Ext OS
4 first area egett Acted upon by Hpu and
starts ca cervix when siree ing ca cervix take
pap smear from transformation zone

lower segment
Rebate relax
7cm size

agnosia
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mmi
a Tis of cosmetic importance
only
fj.gg vertical

Transverse Bikini scar

Pfannenstiel incision

fm
g
classical as Cappersegment

_w
us c shower segment

ala
me
Emacs csc
Heals poorly Bleeds less 9 Heals better
Trail of N Y D not possible Can give a trail of N V D
in next pregnancy in next pregnancy
chance of Rapture 8 lot chance of Rapture 0.5 to 27
only indications I Indications
lower segment tumor fetal distress me
eg fibroid Transverse lie in labour
Bladder fibrosis placenta previa bleeding
post mortem C S complicated Breech
Brow presentation
Rogers rancor contracted pelvis

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Trial labour after 1 section Toral
ofbirth VBA
vaginal after c section
t
can be done only in institute
with previous I Lses

Signs offence
maternal tachycardia
suprapubic pain
fm
g
lose uterine contour
of
Bleeding Plo
Fetal distress Fetal death

_w
d

j ala
common
indominantigidiiammatiustets

y.jo
FEA

3 3 5 2 51m

1 fifthfollicles Antralfollicles 6 7 month 2 6mm size

Primordial follicles
6 7 Millions at 20 coke
of Intrauterine life
I 2 million at birth
3 9 lakhs only at puberty
Generally periods in women are from 12 to soyears
38 yrs menstrual life
of 1000 P f destroyed
i A month l egg
SO 1000 month 12000 year 1.20.000 lo years
38 12000 456000 Used up by 50 yrs
ofage
38 12
no
of cycles 456 period

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THE age of menopause in India at 48 Yu
world ang 51 52 years

MY n'g pubertyphysical growth

specific female puberty Breast Thelance
pubic hair Pubarche

fm
Max growth velocity e Height

g
Periods menarche
age of puberty to 12years
Fatly menarche 9 10years

_w
precociouspuberty es years

ala
Precocious Breast E u years

Relayedperiod primary amenorrhea

No periods no pubertal changes fill 13years
But if she has pubic hairs wait till is yrs
to say delayed

seqegg.gg fimonme ion missing 3 regular

cycles after previous menses
cues
Pcos Pregnancy is the
TB physiological
Asher man syndrome 20 amenorrhea
Sheehan syndrome
Hypothyroidism

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Support of uterus

KEEEY.EE
fm Puffing.at
g
Mesosacral.gg

_w
support
fest

ala
pelvicdiaphragm

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Reaches uterus on day 3 or daya embryo sure
t Stell 16.32tell
Implants on Day 6 earliestl
II
21 to us hrs
gt

f
ovulation or 20th to 24thday
ay ooo
g men mad age corp mm

fm
secretory
g
1 Implant on
endometrium Progesterone

_w
in 15 yr girl

ala
uterine contraction open
the cervix 2
Expulsion
causes Dysmenorrhea

2M hrs

24 to
jiiiiiiiiian
us hrs

or

t
Blood in pouch atDougan completed degeneration on day is

causes pain mittle shmertz Progesterone

withdraw
midcyclepain
sheddingof endometrium

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Ovulatory E anovulatory q
pain at ovulation Mitte shmertz No mittle shmestz
pain at menstruation Dysmenorrhea No Dysmenorhea

shedding progesterone withdrawn shedding is dlt Ischemia

Expulsion e contractions die pg Expulsion is dit uterine
distention and recoil
G Henceirregular

fm
g
ovalaratory cycles Painful regular
anovulatory cycles Painless Irregular

_w
Dyspnea Pain starts 30min prior to onset of periods

ala
stage to hours postonset spasmodic ion
N in all women 1 dy amenorrhea

Pain starts 3 u days prior congestive for 20

y
throughout the menses dysmenorrnea
stays
Endometriosis
Adenomyosis
Ry PID
NSAIDs mefenemin acid
Ibuprofen
Antispasmodics Dicydomine
Hyoscine
combined oops cycles are anovulatory
6 Painless
Surgical dilatation ay cervix by Hegar dilator

Be
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stop the periods by GnRH anolougel given in a
Depot for to down regulate the pitreatory
gland
Pre sacral nerve ablation by laser tort thermal

Renitent
length 28 Day I 7days

fm
21 to 35 days 24 to 35 is normal cycle

Duration 2 7 days g

_w
Amount 30 some cycle

ala
tmall.gg 35daye Oligomenowhea
nnqpatterni
C 2
days Hypomenorrhea
a 20 ml I
7 days menorrhagia
So ml
21daye some polymenorrhagia

metrorrhagia mid cycle spotting eg pop used

progesteroneonlypills
Menometrorrhagia Irregular acyclical Bleeding
eg ca endometrium

9 45 g o f I DM Hint obesity t me nometrorrhagia

A Ca Endometrium

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manpathiakhagia
prolonged amenorrhea Eamonthe fib Heavy periods
if 40 years I self limiting condition
anovulatory cycle
Endometrium on Bx shows hyperplasia
cystic glandular hyperplasia Kate
Swiss cheese endometrium

spend fm
g
a cure examination

_w
Sims also
ala
may a 66 g o E e irregular vaginal Bleed
for f months I
N Examination
first thing
to do I
Msg endometrial
Hieropathology Bx

EtmenopausaBleding period after 1 year ay menopause

mcc ca cervix fin India 9 world wide
west a Endometrial cancer
Endometrial Hyperplasia
polyps
Hormone Replacement Therapy side effects
senile endometritis

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empaneled hidden period
Eg Imperforate tegmen

Hematometra

ematocolpos

fm
Re Sx e cruciate incision

_w
secretion

D ala
FSH
I
estrogen

ai
Progesterone
t

Androgen
ovulation Ilavomatisation
Estrogen
Medio Basal Nucleus
µ Arcuate Nucleus
mane release

I't once in 90min

AFC Annal Follicularcountperovary 6107

t
IV Sr FSH is normally 2 6 I U
Estrogen y
progesterone
t esh estrogen
H progesterone
if FSH is to Iu m suggestive of menopausalage
if FSH is 40 IU m Diagnostic of menopausalage Page no:
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capacity to concieve Ovarian reserve

High low
young girl 20 yrs older 245
Sr FSH 2 610 SV FSH 710
AFC on us a 6 7 ovary AFC E 3 ovary
Size 3 3 5 2.5 Cms Size is small

fm
Sr Estrogen t Sr Estrogen t

g
Antimallesian Hormone 2 6 Amn s Ing lml
ng ont
AMA H
if these findings are

_w
seen in young 9

ala
Poor Ovarian Reserve

single Best fest for ovarian Reserve Sr AMH

Sr Fsk 40 menopause
40 before us years Earlymenopause
40 before 40 years Premature ovarian failure

Best pregnancy channel 20 25 years

Decent pregnancy chanter 25 35 years
35 years T Anomalies T screening required
Abortion eg dual triple marker
amniocentesis
yo years 401 Abortion

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3daye
2
SrFSH

i
Hormone

anatomy

man
hormone
Éfm É i

g
iii www.mmtmmy.OOOOOOOOOOOU X
aw 3d

_w
Hcapregnancy rescuethe corpus luteum

ala
6weeks
Corpus luteum 12weeks

1 placentation till
produceprogesterone Delivery
lento placental shift is at 6th week

Threatened abortion B progesterone Best

Recurrent abortion

Max stretchability
SPIN BARKLEY Helps sperm transport

FERNING
EEE EE on a slide

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Day24Eventsin
nice mucous diet progesterone

R
p
safe P d tr s
f

No sperm transport

fm
No oocyte

Billing's method cervicalmucous method g

of natural contraception
wet days avoid sex

_w
4 Dry can do sex
days

ala
Fertile period safe periodmethod calendermethod Rhythmmethod
6 Day 11 16 avoid sex
C 11
can do sex
1 I
Pharmacological method
continuous progesterone only Pille o 28 days

Thick mucous

1
No egg because the progesterone will
supress LH surge

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ÉÉÉÉÉÉÉe simulation
try and get 6 is touidu
ready under GA 4 Do aspiration i usaguidanie
I
15eggs retrieved
follicular
1
Fertilize them in the lab
Miss 4
assume 10 eggs are fertilized
fm
I
choose 3
franter
g
embryos and
them incetera
64411d
_w
if Day3 2 3 Embryo
msn.am

ala
1st IVF baby in 1978 H
Louise Brown Extra Embryos 2
Edwards t steptoe Frozen in liquid nitrogen
Nobleprize in 2010 1960C

if core goesout of control

6 ovarian Hyperstimulation syndrome on Ss

Plan G 15 by Colt But 20 is excess

1 Egg 150 200 pg estradiol
20 Eggs 400099
i If Estradiol 3500 pg 9 Hca for ovulation
4 T VEGF
d
Increase vascular permiability
G cause Ascites Pleura Effusion
pericardial Effusion Edema
Intravascular Hemoconientration
causes thromboembolism
Can even be fatal
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It
Infertility re totally Iatrogenic Disease
use
of c citrate mcc for mild variety
severe variety Ing Este

Re Ivf to replenish intravascular space

ORALfluids

fm
Iv fluids Best IN ALBUMIN

g
Remove the ascites pleural effusion by tapping

_w
Tests of ovulation assess for progesterone effect

ala
Sr Progesterone 3 ng lml

Sr 211 15 IU urine CH kits

Basal Body tempt By 0.5 F

Progesterone is a thermogenic Hormone

serial Follicular monitoring By USG

usual method for detecting ovulation

Laparoscopic Evidence of ovulation corpus luteum

Endometrial Biopsy done in the premenstrualperiod

6 shows secretory activity
4 also shows adequacy of secretion

Assess by mittle shmertz Highly unreliable method

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serial cervical mucous studies loss of spin barkiet
a ferning is ovulation

Combined OC Ps COC Ps

ve feedback thaPituatory

Iifmd
g
n n
d

d
O
7 Estrogen

_w
III trogesterone
7 Progesterone Engen

ala
ovulation
man an
dlt thepills I contraception
Spill Period Dysmenorrhea
Artificial period
Regular cycles

low dose pills Net Estrogen levels

Tab Ethinylestradiol o 03mg 30mg are low
002mg 20dg I
0.01mg 10mg Coop's is low Estrogencondition
I Proliferation
Rarely I Bleeding ft Anemia
T in Ca lervix It Hypertrophy
t gallstones It ca endometrium
I ovarian cancers
T in HepaticAdenomas
ft ovarian cyst
T Chlamydia PID
ft Benign Breast Disease
Indolent symptomless
d endometriosis
It Fibroids
tf ca colon
tf PID Page no: 17
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contraindications

ala
Pregnancy
lactation estrogen component causes failure
lactation
of
CA D
o D VT
Thromboembolic Diseases
Abnormal liver function Cirrhosis

fm Hepatitis

g
Uncontrolled Dm lipid
migrane Especially I Aura
Smokers 35 years

_w
women 40 years

ala
No contraindication e STD HIV

No effect on incidence ca Breast

of
Start Cocea
Day I to Pay 5 ideal start
inform contraceptive effect take 7 days to
establish when starting 1st time

missedif y ou 2 are missed take 2 today

continue the pack
But if 3,3 pills missed Take 1 today
9 continue the pack
But take alternate method
of contraceptive for next 7 days

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It had sex in the missed pills day give her El
Emergency contraception

Emergency
acting ost coital contraception
4 prevent pregnancy E in 3 days of
an protective intercourse
ABORTION is not a method of emergencycontraception
fm
Re levonorgestrel 1.5mg orally 1 Tab
g
4 if given before ovulation day It ovulation
if given after ovulation day r tf Tubular motility

_w
tf Implantation

ala
7 mifepristone Anti progestin 25 50mg
It Implantation

Yuzpee Regime Coop

2 tab 12 hrs 2 tabs of 50meg
4 tab 12 hrs 4 tabs of 30meg
d ovulation
t Implantation
S E TTvomiting

Brandname
T Ullipristal Acetate 30mg tablet Elea
selective progesterone receptor modulator SPRM
tt Implantation
work well upto 5 days
Not approved by Govt India
of
I UCD Prevent implantation up to 5 daye
most Effective method of Emergency contraception
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Episiotomy Incision given to widen birth canal
and prevent injuries

Jyp
median mediolateral so
Bleed t Bleed t
real t Healing t
scar good scar ragged
painless paine more

fm Hence
extension to uncommon

g Episiotomy
Completeperineal me
Thar is common

_w
Repairs Episiotomy immediately by absorbable

ala
sutures eg Hiroyl monocryl catgut

Vaginal mucosa 1st

continuous suture

muscles Interruptive

Skin Interruptive

structures celt in Episiotomy out to inside

a Skin
Subcutaneous tissue
Superficial perineal murder
transverse
Balbo spongioscer fibres
of levator
Ani
Deep perineal Branches of pudendal
nerves vessels
vaginal mucosa
Isenio cavernous is not cut in episiotomy
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Perinealtears
Type f vaginal mucosa

Type 2 Vaginal mucosa muscles

Type 3 vaginal mucosa muscles Anu É IF.IT f

fmthus
g
4 99inch mucosa mud Rectum

fan Episiotomy is a type I 2nddegree tear

_w
ala
complete perineal Hav type II Glov II
4 Ipe Repair do immediately in 0.7
t
it neglected ape if 24 hrs
These gutends
are colonised to do repair after
bacteria 3 months to allow
scar tissue to
form

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PCOS Prod Stein aLevinthat syndrome

151 Women Pcos

1
Every 5 girls Pcos

me endocrine disorder of reproductive age Q

Pcos is the mcc Hirsutism
of
other causes congenital adrenal Hyperplasia
Cushing
fm
g
Ovarian and adrenal tumors
making androgens
Idiopathic 25.1 of Hirsutism

_w
Everything Usa lab values

ala
are normal but the girl
is hairy

Elegy Polygenic etiology

Genetic
Familial
Environmental

Riagnostic era Roterdam interia

s
Hyperandroginism clinically or laboratory t of Androgens
Anovulation

USG picture Pcos

of
any 2 of these Pcos

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Normal ovary
I
stand puckered Bob I
Pcos Anovulation t so smooth surface pearly white colour

on cut section No cysts

Ring of pearls

fm
Necklace of pearls

small follicles g

_w
20 follicles ovary

ala
Amd M se m
Thick stroma Usa also
slightlyenlarge size
volume sloes

It
mom

iii Estrogen

Estrogen

onomoooooooooots
It grows
1
s endomenum
Tanon the Blood supply and
Infertility becomes ischemic
3
Amenorrhea Shedding
hirsutism dlt t Fret androgenesim
Insulin resistance obesity Page no: 23
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g

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laboratyiggetermano
73 1
T in testosterone
f in Aldostrenedione
I in sex hormone binding globulin
SHBG from liver
Free androgens
Fasting Insulin levels ft

fm
g
FIT's anormation Infertility
4 I irregularcycles

_w
Noprogesterone t no feedback to LH
HghLH

ala
I
acte on stroma
Hyperantdrogenism
Hitsutism
Insulin resistance at the ovarian re rep level

g t glucose
I
IR d Ayp for tell growth
g

IR has a cutaneous markers y

g Acanthosis Nigresans
Dark shiny velvety
deposits in rural
HA I R A N HARAN Syndrome areas
6 seen often in Pcos

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4 Plos metabolic syndrome t ca D later in life
d
weight a BMI
t wait 35 inch aka syndrome X
t sugars
f lipids
t Br 130180

fm
poos also T in DM MTN

g
Ca endometrium
ca ovary

_w
Ry 1st line life style modification Ls m

ala
Exercise
Diet
loose weight

Irregular cycles a coops

An ovulation ovulation Induction

loose of the circulating insulin becomes more

sensitive to the end organ 301 ovulation

Insulin sensitisation metformin 301 ovulation

Specific drugs
hypothalamic Estrogen Receptor
ovulation in soy cases Day 2 to Day 6
4 Pregnancy in Uop laser 50 250mg day
4 Twins in f lot
Drug Chlomiphene citrate
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Sle Headache
Flushing
Rarer visual scotomas

Aromatase Inhibitor Lebozole

Androgen Day 2 Day G
Aromatase0 25 5mg day

ft Estrogen
fm
TTFSH

g
Twine only 31
Anomalies ft
Endometrium is better

_w
ala
Ing FSH
Ins Hmas

Hyperandrogenism
Antiandrogens
1st line a spironolactone 50 to 100
mg day
Next cyproterone acetate 100 to 200mg day
cosmetic B Gprogesterone e antiandrogen effect

if no response to anything
Sx Mx t laparoscopic ovarian drilling
I
Burn u holes in the ovarian stroma
to reduce the excess local androgens
Pin local 1
0 O
androgens Better follicular growth
makes thefollicles 000 00
Very hard
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Mcs young girl estrogen proliferation
Irregular cycled t cyproterone secretion
Hirsutism acne aletate antiandrogen
fort
Estrogen
Drostpivenone yasmin yamini
Ginette Diane
Infertility
fm
ag couples are infertile

unprotected intercourseg
definition No pregnancy even for A year after

Same for 1 a 20 in fertility

_w
why l year

ala
Be louse 901 couple concieve in year of tying
Be louse 801 couple concieve in 6months tying
of

causes
male alone 20 3Gt oligosperma
azoospermia
e
psychiatricdisorders
erectile dysfunction
premature ejaculation
H o testicular surgeries
varicocelectomy
Hydrocelerepair
orchidopexy
Epididymo orchitis
mumps
filarial infection
Tubercular infections
Smk Alc
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Female alone 30 501 e an ovulation overall mec
most treatable cause
Endometriosis Tuberculosis PID
Ho m T P can cause endometrial
or tubal damage
Smk talc

Ft M factor 10 407

fm
Unexplained 10 20 t
g
i male may be responsible in upto 505 cases

_w
ala
management of Infertility

Take Alo coitus

Frequency Best is every alternate day sex in
fertile period
Technique coitus
of
Examine male Rule out testicular atrophy
penile defect like hypospadiasis
phionosis
Female Rule ay mullesian defelt

Lineati gate semen analysis

seminal vesicles secretion
tot alkaline
cysemen fructose

Éffffy
Prostate not acidic
sperm lot
Net pH Alkaline 7 2 7.3
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Semen parameters WHO 2021 WHO 2010
Volume 1 a ml 1.5 my
concentration 16 million ml 15 million ml
Total count 39 million 39 million
Total motility 42 f 40 f
Active motility 30 t 327

vitality 59 t 58 t

fm
morphology 41 41

g
pas cette c 1 million mysemen A million mysemen

Single best parameter

_w
ala
women e check for ovulation
Anatomy Pelvic examination
Tubal assessment pmeglumineDiabizoate
Hysterosalphyngography Radio opaquedye
instilled into uterus
and tube
observed under Fluoroscopy

In imaging Mre is best to check uterus a pelvis

overall Best laparoscopy feysteroscopy chromotubation

mize

mm
leech wilkinson cannula

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Re

_w
ala
1 1st Fertile period coitus

2 Follicular monitoring timed intercourse

3 Ovulation Induction Follicular monitoring

timed intercourse

4 Intrauterine Insemination IVI low counts

fm
But at least 5 10 million
Mk tubes
g
at least I should be open
washed sperms are inseminated into the uterus

_w
indications age.o

ala
cervical stenosis
Cervical anti sperm Ab
oligospermia
Endometriosis
Sulser IVI 251
of
5 IVF Indication
all IOI indication
Blocked tubes
unexplained infertility
success 451
of 3IVF
Take home baby rate 251

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in cases oligospermia c I million
ser or
of
a zoo spermia obstructive E Normal FSH 9 H
where sperms are derived by testicular or

Epididymal aspiration
6These sperm even if I or 2 are morphologic
normal sperm t can be inseminated directly into
oocyte
fminjection
Intra cytoplasmic spermg ICSI

_w
Nonucleus in egg

ala
Dispersed genetic
material in cytoplasm

IVF
assisted reproductive techniques are
Iggy 4 Both gametes handed externally

I UI is not a Are

events
of fertilisation
1
capaitation gettingready for fertilization
lossof cholesterol

µgg
Sitz
Gain of Alps Cattlevels
Tse in motility
2 A120some Rx n 100000 spermsbreak their
heads and release hyaluronidase
Yamada 4softens the 2 P G Allows
I ÉF a sperm to go inside the egg
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3 Cortical Ryn Rehardencing of that
2 p so
f Zonapellicuda no more
sperms go inside

j
prevents polyspermy
it
Size 1204m
of agg
size of sperm 18Mm

fm
É É f's atiinogrademininiesg seminar as
I all women

_w
Retrograde menses Ram is seen in hot of all women

ala
But 10 ay women who have poor
ensnare
Endometriosis
sImonm
imgur.it
seen in obese red meat eating g
Age 3rd to 4th Decade of life
25 35 yearsaycite
Piggyp
Power burn lesions
chocolate cyst
Adhesion
M1 site deposit ovaries
of
and me pouchay Douglas
Rectal surface
Bowel surface
Bladder surface
Diaphragm surface
peritoneal surface
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Rare cesarean scar abdominal scar endometriosis
Episiotomy scar R local excision

Share vicarious menstruation

lung Periodic Hemoptysis
Eye Periodic sclera conjunctival Hemorrhages
Nose Periodic Epistaxis
Brain Periodic Headache

fm
Diagnosis
Usa showing a g cyst app
ground glass
MRI Best imaging

_w
Diagnostic laparoscopy t Best diagnostic

ala
CA 125 may be increased but not specific
because it also t in ca ovary g gutcancers

Rx Surgical Re of all gross disease

I
cystectomy
Adhesiolysie
Deposits Fulgration Yetman
2
60 707 Recurrence
I
Prevent this by mmx
ay Endometriosis
NSAIDs pair Relief
CocP a limit endometriosis
Progesterone Atrophy by secretion a
stabilization continuously
Inf Depot medroxy progesterone acetate
T Dineogest 150 3rdmonthly
2mg op
Page no: 33
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Androgens faster atrophy
6SE Hirsutism male type baldness
aine Hair
Tab Dan9201200to 400 Virilisation Breast Atrophy
Tab Gestrinone permanent Attosomegaly
Hoarseness
Ifindication to
stop androgens

fm
by inducing dow regulation
GnRHanalouger Atrophy

g
d desensitization of the pituatory
leuprolin
Nafrelin etc
I GnRH
_w
pulsatile 1190min
Item
ala
continuous regulation
IIIgown d No L H Io F S H
Endometriosis a
surgical removal of all gross lesion
d
medical management
L
Pregnancy Coop

NB GnRH a 6months No estrogen for Gmon the z

osteoporosis
amrita are required 76 months give holdBack
Therapy
I
Cocodosa Estrogen
Tibolone
Raloxifene

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Adenomyosis older f yo yrs a multiparous

Endometriosis interna I in the uterus

multiparous yo yrs lady

Sev progressive Dysmenorrhea
menorrhagia
Uniformly enlarged uterus t

fm always
size f la im

SL g
Diagnosis USG MRI uterine Bx showing smooth

_w
muscles I Blood

ala
R Best R Hysterectomy

Usg feature lossof endometrial myometrial distinction

myometrial Hyperplasia
myo menial laker
Dash and Dot appearance

Hormonal Replacement therapy

main indications Hof flashes

osteoporosis

main C I CAD

when to
give after 1 year atleast it menopause

Page no: 35
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CII of menopausalpts
abn liver function cirrhosis Hepatitis
uncontrolled Dm Hen lipids
Follow up
ay ca Endometrium
Ca Breast
KClo DUT
Thrombi Embolic Disease
KILO CAD
undiagnosed vaginal Bleeding
fm
Before starting HRT Do these g
LF I

_w
FBS PPBS

ala
lipid profile
E 19
mammography
pap smear
Endometrial thickness should be E Umm

why to give HRT

Skin is loose in menopause dlt loss of subcutaneous collagen

Body hair will be more prominent in menopause
Hoarseness
Osteoporosis q me o P t vertebral compression
wrist Neck femur
of
Hot flashes dft The
Dopamine
Nor Adrenaline
Serotonin
mood swings
Depression anxiety insomnia
Page no: 36
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Pelvis T
vaginitis T Vulvitis TUrethritis dlt lossoflactobacilli
Dryness No sex life
t pelvic organ prolapse

Rugs
Tab ESTRADIOL 1 2 mg day Progesterone

fday
Tab to prevent
mg
conjugated equine estrogens
0 625 1.25mg Ca Endometrium
if uterus is
presentonly

_w
ala
Tab Tibolone 2.5mg day synthetic estrogen e
progestational metabolite

Tab Raloxifene SERM 60mg day

Estrogenic on Bon good for osteoporosis
anti Estrogenic on Brain sie Hot flashes

Plant estrogens Soga safer alternative

But less effetive

Bisphosphonates
Good non Hormonal Px of osteoporosis
It osteoporosis

BE for osteoporosis so yrs

age is are estrogens
flowerer if est are given 710 years they can cause CAD

i for 760yrs age Doc Bisphosphonates

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Recombinant pen Teriparatide
only drug e makes new bone

Denosumab monoclonal Ab

Hof flashes Dos Estrogen

But takes 2 3 coke for best action

fm
i meanwhile we can give

g
clonidine HI 100mg HIs fVasomotorflushing
Hentral anti rent
SSRI 4 Fluoxetine 10 20mg day

_w
CAD Natural

ala
man ve woman yoyears incidence q estrogen are
man ve woman Gogears inciden ie p cardio protective

But HRT Iot

intact if HRT is given toy us can cause CAD

asmigger
type
me Adenocarcinoma t Endometroid type
serous cell and clear cell variants worst
prognosis
Etiology Hyperplasia dlt T Estrogens

HRT
an ovulation Pcos
Tamoxifen e given for prevention of Recurrence
in ca Breast cause estrogenic action
on uterus at ca endometrium
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Estrogen producing ovarian tumors
eg granulosa cell tumor

Early menarche late menopause

i T periods Henie 4 Exposure to estrogens

Obesity fat cells a

anmatisation
Androgen estrogen

fm obesity
Corpus ca syndrome
g
in Don t Hen f

Familial disposition

_w
if a q has Ca Breast degree female

ala
la endometrium relative can have
ca ovary either
of these
Nulliparity No progesterone
No break for estrogen action on uterus

Hyperplasia
simple Endometrial hyperplasia without afypiofhdmth.am
Ijogesterone
Compound Endometrial hyperplasia without atypia 3 y

simple endometrial hyperplasia with Afypia 8t simple

29
J Hysterectomy
Compound Endometrial hyperplasia with Afypia

thIrregular acyclical Bleeding me nometrorrhagia

in a woman i Dm Hen obesity
Page no: 39
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also Post menopausal bleeding
pyometra Dirty vaginal Discharge

management of Irregular eyelid Bang

1st examine and rule out gross local lesions
E the 1st Inv is a endometrial Histopathology
painless
Jbcedure by a pipette Endometrial office Biopsy
4 80 got sensitive

fm underAnesthesia
95 991g sensitive
Da c in 07

_w
nessieroscopic
100 f Sensitive

ala
i Usa is a good adjunctive investigation

Biopsy shows endometrial ca

I
Do all lancets in gynecology
surgical staging
Hysterectomy t are done surgically but
pelvis and para aortic ca cervix is staged
C N Biopsy
I clinically

stage I limited to the uterus

IA Endometrium 42 myometrium
IB my omentum 12
Stage I cervical involvement
stage II
II A serosa peritoneal deposits
IB vaginal metastasis Parametrial
involvement
I C G Pelvic c n
Cz Para aortic C N
Page no:
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stage II
IA Bladder Bowel
Ib Distant metastasis

R
stage I No further Rx
stage I Pelvic Radiation
stage Individualised a
É
stage
fm
Mcc site
of
Recurrence Vaginal g
vault
4 est line Re Progesterone therapy
of

_w
Pregnancy endometrium ala
best depends on staging of ca endometrium
also on grading of cancer
LN status
ER PR status

SIMS CURETTE BLAKE CURE F pipette curette

endometrial Bx

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É9tToMe HPV 16
serotypes again
Mc tumor Fibroid
Mc malignancy caBreast
me genital ca ex

18 malignancy
most malignant HPV
a vaccine against a High risk serotype Nonavalent
16118131 1331 9515215 vaccine
Iggy GARDASIL
schedule Day
fm
0

g
2 months all 9 to 45 yrs of
6 months

_w
Prevention is got if given before Exposure against these

ala
Prevention is not if given after Exposure 9 serotypesonly

i Even after vaccination continue screening

SHE guides Strategic Advisory Group of Expert

on vaccination give a vaccine to all girls
between 9 In years

Etiology sex
E many partners
partners E STD
Comercial sex workers
Early sex

low socio economic status

Smoking women
a w HPV Also HN G HSU

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Screening Best by pap smear
cost effective method Via
visual inspection i acetic acid
How Pap smear

whom All sexually active woman 3yrs

of 1stexposure
Frequincy

fm
once in 3 yrs till 30 yrs age

30 years Do once in 5 yearsgif

pap smear is negative

_w
co est
HPU DNA is negative

ala
730 years if only pap smear is done a ve
once in 3 yrs only

765 years No move pap smear required

How to do
use ayres spatula cytobroom or astobrush
6 Rotate this 360 once
4 make smear on a slide
fix immediately by 951 alcohol
4 store in coplin's jar don'tdry
stain t papinculous solution
Best method
of cytology is liquid
bared cytology
Taka smear rinse in media
sediment centrifuge media
Gsmeared on a slide
cell loss is minimized
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Interpretation of pap smear

New Celle Atypical Neoplastic cells

T
on the epithelium Cxaf
Intraepithelial neoplasia
Dysplasia Bethesda classification
if z are abnormal CIN I Lasil lowgradesq Intra epi
if f 3 are abnormal CIN I lesion
Has it

fm
if 733 are abnormal Cin

g
if all cells are abn Cls

CIN I I CIN H calx

_w
ala
Ri
CIN I Frequent pap smear high risk
cheek HPU DNA status low risk
NB 760 t will spontaneously Heal
Bright illuminator
CIN II 14 sox magnification
Has it CIN I Rule out Invasive calx colposypic
Bx
Bytaking a Bx
Highlighted
Acetic Acid
schiller
Iodine
lugou
Green filter

feasil city Biopsy colposcopy

Aceticacid
11 I Iodine
Grain filter

PCB post coital Bleed

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I
Biopsy

170 D
fm
Invasive ca cervix Biopsyproven CINI
Ry RadicalHysterotomy
g proledere
R loop Electro surgical
Excision
LEEP Best

_w
older It conization

ala
Hysterectomy

CIN I Hasic Colposcopic By t By proven CIN TH LEEP

Hasil

symptom of ca ex
me symptom Post coital Bleeding PCB
also post menopausal Bleed
Foul smelling vaginal discharge
ca cachexia
Uremia MC 100 in Ca cervix
mi type of Ca Cx t sq cell Ca
large cell keratinizingtype

PCB COLPOSCOPIC BY
PAP SMEAR
Page no: 45
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staging clinically
Ply exam
PIR exam
Cystoscopy Bladder
proctoscopy rectum
Imaging Usa la ete
for stage III e

fm
gdepth
A microscopic cancer
if Al C 3mm

_w
B Clinically obvious

ala
B C 2cm 132 2 Gem B374cm
ureter IA uppervagina
compressed

I B parametrium involved But shoot

IIA lower 13vagina of Pfd way
Mr stage of presentation IIB Parametriuminvolved till sideway
to OPD in India Ls flydronephoosis
IIc c pelvis c n Cz parao oshi en
IA Bladder Bowel
B Distant metastasis X Inguinal in

La of cervix External iliac sentinal l N 1st2 N

obturator
rectal sacral
B Stage I to A a Radical Hysterectomy
I Az chemotherapy Radiotherapy
Chemo radiation
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Tetterton
I simple hysterectomy
I t Radical by WER Heims
uterus t
42 q morethan 12 ligament
lymphnodes
II 1 Radical Hysterectomy Meigs
complete ligament
fm
Yggnapengff g

_w
extended radicals
II
Mi site
ay ureters injury
in Hysterectomy
ala
Where ureter mosses uterineartery
in over all surgeries at the pelvis brim

Fibroid aka leiomyomalmyoma

Mi tremor of women Age 35 50years
307 all women
of
50yrs age 7801 have fibroids

Etiology T Estrogen
also T progesterone associated
Red meat eating obese women
af w growth factors
platelet derived G F
Basic Fibroblast G F
Transforming G F
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Insulin like a F
XEGF
Familial predisposition 2 s times
more likely in Relatives
chromosomal defect

Pathology
monoclonar tumor

fm
t monoclonal muse makes many

g
whirls muscle cells
of smooth
Pseudo rapsale
always start intramural and the uterine f 2
_w
contractions will move the fibroid

ala
inward or outwards
sutmuw.us Tuberous

Eiga drinkin of fibroids

8 cervical fibroid parasitic

7 Subserosal pedunculated
6 50 y intramuscular rest serosa

U Intramural fibroid
3 1001 intramuscular touching cavity
2 7507 intramuscular partly in cavity
1 C 507 intramuscular mostly in cavity

f L o sub mucosal peduculated

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Symptoms
met BleedingTt
Reason Aneffective contractility
increase endometrium
Coral vasodilation prostaglandins
Pain
dlt compression of other organs
compaction t other organs
of fibroid
fm
Torsion

g
Degeneration in fibroid
MI is Hyaline
me in prig Red degeneration

_w
No Sx conservativeMx
start in the 2nd trimester

ala
rare malignant degenerations
Kit sacromatom degeneration
others calcific womb stone
lipoid
cystic degeneration

Infertility Tubal compression

Foreign body action of celery
6 contractions Expell the embryo

Bladder Initially Hesitancy

later retention
of urine

UB

Lf
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i main PB I Pain Bleeding Infertility

Diagne
usa is good
Mri is best mapping method

KWELI No P i3 I 1 NO R Required
sim
small semi T P Bl I seen R Required

fm
large corm E PfB I t R required

g
large 1310cm No P i3 I 4 R Required 2
Because later it can undergo
torsion and degeneration

_w
R

ala
age go yrs hysterectomy oophorectomy
completed family only if 350 yrs

young woman
wants children

Iii.in
laparotomy any type
wana menstruate fr laparoscopic type 7,6
a 5
opiaeeyneon
1 fibroid I 15cm
myoma screw

meamanagement
Purpose f Pain
I Bleed
t size
t vascularity especially before surgery

NSAIDs t Pain t Bleeding

Coop It Bleeding
Page no: 50
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continious anrna leuprolin etc e f size
stops bleed
vascularity
GnRH antagonists faster action ay pituitary suppression
cetorelix Gamivelix etc
mifepristone anti progestin anti growth action
Ullipristol acetate I 5mg Iday sp rm
uterine artery Embolisation P V A polyvinyl alcohol

fm names
g
lyft
_w
ala
thee High intensity Focussed use

É
Candor sq.eeu.cat 951
also melano carcinoma 3 47
MI site labia Majora Got
2nd me is clitoris 151
Age group 60 70 yrs
me symptom t pruritis
Bleeding Discharge

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predisposed by a
sq metaplasia
lichen sclerosis
HPV16 smoking e predisposes ca vulva in young9

Sx for ca vulva is the cause of 901 mortality

in ca vulva

lymphNode involvement in ca vulva

fm
me Sentinel Ns Rnguino femoral N
group
g
of vulva can cross the midline
also lymphatic drainage

Try and do limited sa s check if c n are involved

_w
é cancer only then do lymphadenectomy

ala
Sentinel c N Biopsy is very important
use methylene blue Technitium 99
By the L N involved first
camel 4 en ve
do cympnadenectomy Donot do
also lymphadenectomy
A
A C 21m Simm depth invasion
stage I limited to vulva B 2cm Simmdepthay
stage I Involved adjacent organs t lower urethra
lower vagina Ancel
stage II Inguino femoral l N

ACE
BCE

Stage II Involved adjacent organs e upper urethra Bladder

upper vagina rectum
stage I Involves pelvis lymphnodes Distant metastasis
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wide excision Lnt can
Stage I t Sentinel N Bx
LN I No call
stage I Facial vulvertomy BIL LAD

Stage I Paliation RTh

stage I Ice
Chemotherapy Mitomycin
fm
g
5FU Fasouracil

_w
ala

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Qbstericscoring
Gravida state of being pregnant
Parity para act
of delivering a viable Baby 728 wks
Abortion Delivery
of a fetus before 28 weeks
live or dead
Term 37 42 weeks
Preterm 28 37 weeks

fm
Post form 42 weeks

Naegles formula of expected date of g

delivery
9 months 7 7days

_w
last menses period 1st may EDD 8thFeb 2024

ala
Malliparity e Never delivered
multiparty 32 deliveries
Grand multi gravida 4 757 pregnancies

Examples GP A obstetric score

1 Pregnant
Delivered time Ga P C Ao
I live child

2 I Pregnant
3 Delivered 3 time Gg Pzl Az
n civechiiddmay
2
2 Abortion
56
3 Pregnant
1 delivery 92P 2A
2 live children
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4 Pregnant
7 deliveries 92217CzAly
2 live children
14 abortion

5 68 years
11 deliveries 9191 3As
3 live children

fm
8 abortion

6 20 years g
a.m

_w
0 Abortion

ala

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Index 3 levels

Female male TDF testis

determination factor
chromosomal 46 xx yexpf spy sex determining
Genital gonadal testes
sex ovary region Y
Ndr
phenotype sex vulva Phalle

Genitalia
fmpathless
Internal genitalia

g epnn'll
WOLFIAN
mesonephric

_w
ala
TEF

epididymis

inn Hormone
1 11509s

mall inhi Mls

substance

External Genitalia
is a common genitalia till 6 weeks
of embryological life
7th week onwards distinction start Based on
Androgens
Genitaltubercle
Geneticphenotype

gential swellings o 9Year'sp'Gaire Tes

mated 4 Female F
Ecan
ti.mnepntos
Teth's oath'll Truehermaphroditism
Mt F chromosomes
Antdrogene absence
of Mmt IFanitaiiatiistran
Fusionswell scrotum androgen
h
Increasetubercle p
Desiantaytestes dlf
JJ cower15th
androgenaction on Baskatscrotum quagga egg
gubernaculum
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If mayor
mullerian agenesis
Rokifansky Kastner
Androgeninsensitivity synd
Testicular fiminisationsynd
Hauser syndrome
Normal looking 9
i no literal GG xx karyotype 96 4
ovaries Gonad Testes condescended
inguinal
absent uterus tubes absent canal

fm
shallow Blinding vagina shallow Blinding

g
normal vulva Normal lotatabgen
Feminine Breast Feminine a
Étgomatase
Absent periods Absent

_w
Breastdevelopment
20 Song di Androgen 200 goong

ala
HI 20sexual s I
charact 4 Differentiating At
Pubic hair

In TFS Remove the un descended testes after pubertalage

Galt Rio testicular ca

Congenital Adrenal Hyperplasia

Adrenals Ann I th H
d

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if early onset in intrauterine life congenital adrenal
hyperplasia Cath
if car Happens to a girl
to
penis
Notester
J 411,915
Under
landed ambiguousgenitalia

if late onsent adult onset Adrenal Hyperplasia

A normal girl get virilized at puberty

fm
Clitoromegaly Breastatrophy Hoarseness

Ry for both conditions long gterm steroids

_w
UGxx woman UG xy man
1 Ban body Isex chromatin no Banbodies

ala
65 0 Turner syndrome 47 xx y Klinefetters
No Baw body 1 Banbody seen

short stature Tall stature

sheid chest Gynecomastia
web neck obesity
Cocuset Hairline d
coarctation awospermia
Abitur valgus Infertility
lymphedema mental retardation
7
streak ovaries gonadalagenesis
lowest small uterus
um
my gammy

Kmethstatic amenorrhea then a ten

Anosmia i
no ovarian cycle

SÉamÉnÉÉa dit postpartum pituitary necrosis

Meg lactational failure after ppm in delivery
Page no:
58
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Mullin'an abnormalities

_w
ala
Gartner'scyst

judo If
uppervaginal ant
asymptomatic cyst

R Simple Excision

Bartholin gland Greatervestibulargland

I
fm
columnar g
lubricate during sex
Gland
Duct Transitional to squamous

_w
Blocked Bartholin cyst
infection Bartholin Abscess

R
ala
marsupialisation Excisioning a cavity

iÉ

Transverse vaginal
vaginalseptum vaginal mullerian
atresia agenesis
Cryptome now hea
I 11 1

B Vaginoplasty puberty Re Haginoplasty

Fenton's
Done before sex life is
planned Page no: 59
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Cayetana defects

Didelphye safest mallerian defect most problematic

mullesian Defect

origin
iIIII Tigger

fmAbortion
g term labour
Abortion
Pre term labour Pre
Malpresentation Malpresentation

_w
ala
semimammondetect Distinguish
Bicornuate uterus

Intercornual dietanie
991m 791M 7

siimmi Angle
Best imaging MRI
iq

overall Bestmethod
laparot Hysteroscopy
symptoms infertility
Abortion PTL
PTL Transverse lie Breech Transverse lie
B messleroscopic resection R Unificationi'metroplasty
Strassman

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ABORTIONS

spontaneous abortions Induced Mep

lossof fetal before viability 971024 weeks
ie 28 weeks

causes
1st Trimester me chromosomal causes mi trisomy

fm
also monosomy 95 0 4 met 16

g
Next 18121
more likely when pregnancies after
are 35 years age
i screening is best for prevention

_w
ala
Screening Aneuploidy Diagnostic
12coke dual marker It 10 Bake chorionicvillussampling
Preg associatedplasma karyotype geneticanalysis
PAPPA My
protien A
HK
KLEINE
1200kt NTNB scan
Nuchaltranslucency f 3mm
Nasal Bone absent short

16 wk onwards Triplemarkers 1618 Amniocentesis

Total skin tells
AFP I
are taken
uncojugatedenio t

160k onwards Qadsiple marker 318wke cordocentesis

HCG Fetal Blood
AFP I
Utz uncojugatedetriol t
Inhibin A t
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Non invasive prenatal rating Nin
e around 12 week onwards cell free fetal
DNA can be seen in the maternal circulation
sensitivity 981 Not 100ft
I Hense this is a screening test

2ndtrimestermme
anatomical cause
septate
fm
g
Bicornuate
unicornuate
Short cervix incompotentos

_w
ala
Short cervix C 2.51m m it McDonalds
4 Do cerclage operation
Apply 12weeks
Remove 737 weeks to allow delivery 58.0
worms

Pre natal cordage

Cervia isthe mic Eucerclage
lash a lash 4 Shirodkarstitches
Benson Durfee very short
page wrapping services

Abortion
1st trimester chromosomal she
DM
2nd trimester anatomical Hypothyroidism
Syphilis
Tendency to cause APLAsyndrome
abortion bymaking TORCH
i manymove cause
more thrombi
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Recurrent Pregnancy loss RPI
73 preg losses RPC
Mil is chromosomal
also anatomical
APIA synd
SLE
DM

fm
Hypothyroidism

g
NB TORCH will not cause RPL

Rubella mother to child transmissions 90 951 in 1sttrimester

_w
2nd 657 end 2nd trimester 257
of

ala
Toxoplasma MT et in 1st trimester lot lanes anomalies
2ndTrimester 601 4 No anomalies but
causes Congenital
Toxoplasmosis synd
Cmu me mice infection
has lot
But imy
of inherent immunity in the
community
if meet occurs before 16 weeks tthen 5 Gt
Effected baby

Resetting are
Pain abdomen
Vaginal Bleeding pain Bleeding Pt
Eg 1001 s u exam

gyp
Os is closed
Ut size P O G
D Threatened abortion
Rx Rest
progesterone
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Pain Bleed
Ptu exam

f
OS is open
Products Bulging
D Inevitable abortion
4 Do a DEC

Pain Bleeding fPain

mgBleeding
No passage of products no passage ofproduct
PIV exam os is open Ptu exam os is closed

_w
products felt complete abortion

ala
Incomple abortion

Usa looks 12 wks fetus Dead

É
miss
abortion

Usa at s

J
gestational 91dm
sac only
Anembryonic
gestation

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Indusedabortionen act pasted in 1971
1stAmendment 1972
can be now done 29 coke latestamendment 2021
20 24 wine Two doctors to opine
Indication of an Abortion
mother at risk Sev cardiac risk Renal Ds ele
fetus at risk Anencephaly multiple defects
I

humanitarian causes pregnancy due tovape

fm
Failure
ofcontraception

who can conduct an abortion g

Gynecologist MD Msf DNB Dao in Gynecology

_w
Doctor trained in ay nee x o months

ala
Doctor who did 25 mere under supervision

No Alost ASHA PASHA Blah Blah Blah

method
1st trimester medical abortion by drugs
India 991 suis ese x 7 wks
951 Success x looks
Mifepristone 200 to 600mg Oval anti progestin kills fetus
after 24 hrs

Do usa t rule out ectopic pregnancy

t
misoprostol 800 meg vaginally PG E 1 Expelefetus
6 Done only in uterine pregnancy

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Shea emanation
Electrical
manual valum alpirathkarman
cannula
Mva Klf size prig duration

Mva can be done upto 12 weeks

fm
pressure 610 660mmHg

g
as a opp procedure

a
_w
4ovum's forceps

ala
Hegast dilator
laminania tent
ed seaweed e im bides
ovum's forpep fluid by Hygroscopic action
6 wake in 12 26 hrs

Dilapan synthetic dilator

921 a worse in one

Drugs for 2nd trimester abortion prostaglandins

Pat misoprostol Tabs oral rectal vaginal

Pat 2 Dinoprostone a Tab orally

Get vaginally

PGE a Carboprost Injection given Intramuscular only

In none

if nothing worke Hysterotomy

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thfgrameMonnea die endometrial detrition
die Endometrial TB Healy i starring
dlt overzealous curettage beyondstage of
AUB Grating sound a
me p BubblingBlood
curettage

symptoms
fm
suspomennea

g
Amenorrhea
Diagnosis Best by flysteroscopy
Us at showingfibrosis

_w
Hsg filling defect

ala
R flystereoscopic Adhesiolysis fl b
estrogent progesterone therapy
to rebuild the endometrium

YfÉfj ainge hematogenousspread

es
1st organ involved a Fallopian tube
S
start al Endosalpingitis
d
calcific
rigid
Beaded tube
I Hydrosalpinx tobaccopouch app
Blocked tube Infertility seen

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nO

ala
IÉfTdo menial era as hermann syndrome

Eng e'mid
By AFB stain an staining
AFB culture L J media inGeeks
TB PCR
TB Genexpert automated PCR
CB NAAT

fm
Re Att

g
HRze 2months
HRE 4 months

_w
be Inflammation appeteorgant
Mcc chlamydia
IindolentDid
prevalence wise
ala
me e symptoms to the Opp Gonorrhea fever
Pain
Also TB is common discharge ete

Others Mycoplasma
area plasma
Bacteroides
Hemophilare species
Bacterial vaginosis
satem
pain Abdomen
menorrhagia
Dysmenorrhea

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Signe
febrile if fever is 100.6 F I admit ER
T in The
f in ERP
Pla exam lower abd tenderness clinical
Pu exam's lexical motion tenderness triad
Adnexal Tenderness t
sufficientfor
PIDdiagnosis
fm
additional criteria culture

g
Endometrial Biopsy G chlamydia Mccoycell line
gonorrhea Thayermartin

_w
Elobarate criteria

ala
Usa showing a tuboovasian mase
laparoscopy showing inflammed pelvis
Best Ax PID
of
Re of PID Broad spectrum antibiotics CDI
Ing of cephalosporin I shot
Cefoxitin cefotaxime leftriaxone Kille
1 2 IV Gonorrhea
gm
Tab Doxy 100mg BD x 19days kills chlamydia
alt Azithromycin especially in
preg

Tab metronidazole 500mg BD x ladaye kills anaerobes

alt clindamycin 400mg a B vaginosis
Effighangan recurrent east
PID
PID Regimes

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Vaginitis
vaginal infections
pH ofvagina u s acidic lactobacilli
t glycogen monosaciharide
lactobacillus 4202 Immunity
t lacticacid from
Estrogens infections

fm
g
acidic pH 4 s candidiasis
alkaline pH trichomoniasis can even be seen
15,551616 t B vaginosis in a shift of pH

_w
ala

Page no: 70
 fm
g

_w
ala
ELOPING nancy
Incidence is 1 2 f

Pathology site mis is tube

me in tube is ampulla
Rarely Abdomen and ovarian ectopic
primarily or
FATE
fm
10 5 2 20 Secondarily

g
still rare in the cesarean scar uterine
in the cervix Iravest
Time
ay rupture

_w
Isthe mic fist Ruptured at
a u to books Earliest

ala
Ampullary tot Ruptured at 6 to 8 coke me
Interstitial cornual Ruptured at 12 to 16 wks last

Etiology mix of ectopic Repeat ectopic pregnancy

most significant most important cause cyanectopicJ
1 Ectopic next 1st chance of ectopic
2 Ectopia t next 307 chance of ectopic
PID
of ectopic
a
mic pregy
4 sales es micro diverticula
formation

Previous infertility R P Ectopic

pregnancy
Previous tubal surgeries kibectomies tuboplastice
no Endometriosis pelvic TB

Page no:
 fm
g

_w
ala
EU CD users
Pregnancy is less a ectopic is lesser
it she gets pregnant then rule out
ectopic pregnancy

Effi
52 Aggie
fm
Pop user same login as Ives

Edeafmannetopispregnancy g

_w
me im item pregnancy

ÉÉ ala
outgrows the blood supply
of fire F Tube
2
Embryodies progesterone withdraws
vaginal bleeding I
sheddingay endometrium

Symptom
1 VaginalBleeding
is pain Clinical 2 Tubal abortion
Vaginal Bud
after a period of
JEctopic
triad of
prig
3 Rupture of ectopic

amenorrhea
syncopal attacks

signs Abdominal distention

Evidence
of Hemoperitoneum
a Cullen sign t penumbilical Bruising
b Turner flankal Bruising
sign

Page no: 72
 fm
g

_w
ala
Plo exam cervix motion tenderness
Fullness in Pouch of Douglas cul de sac

aldocenteste
N shots non clotting Blood
mm
Ija
nÉi
Diagnostic of a hemoperitoneum

fm
Resuscitation Planthe Sx g
laparotomy
laparoscopy

_w
it patient is stable
h

É Sy Itasapingectomy
ala
B og un ruptured ectopicpreg save the tube

8É JEET's'atingostomy

medical my surgical Mx
methotrexate Ivor m c size him linear salpingostomyest
faille the fetus Hea 5000 Resection anastomosis

incarnadine

Eadydiagnosis gestation sas cardiac activity Mre Better

Better at weeks st weeks thangers
i ga g when et where
But time
consuming
Page no: 73
 fm
g

_w
ala
But sometimespregnancy is not visible on Tv
also the doing Hrg levels will help

Discriminatory zone
of HCG level
if Hca is 1500 f U r can see a sac by 7 v s

09.05.2023 06.0512023 because Doubling occur

400M IV 800 m Iu Intrauterine prey t in 48 are

fm
400 m Io 480m IN a likely Ectopicprey 5 7 daye
EPI g
91nF ang de normal preg

_w
if 5mg di Ectopic prig

egg
ala
PNstage Days

11 I ping 46
ydividee
Geneticmaterial zygote
will condenses
make pronuclei PM
pay
yell
II
2
Day
Day 5 8tell
Hatching a maker fetus
implantation Inner'mass
WIEHE selle f
t
KI
makeeplaunta T
morula
Terophontgerm 16.32 tells
Page no: 74
 fm
g

_w
ala
monozygotic twin
Embryosplite
Identical twins

It 11250 pregnancies
mostly dit familial
0 a geneticpredisposition
f s tell IF T
maternal family
Each tell is a tell H o twins e more
tofipolent stronger influence

fm
g
splist f 3
day of embryonic life Di chorionic

Vee Di amniotic
Di Di

_w
307 safest

ala
4 3 to 8days I monochonionic Di amniotic
Split
Figgmmonest
EÉ
Splits 78 to 12
days s mono chorionic monoamnione

11110
mo mo

clad
split 12 Days 1 conjoint twine
we Saimese twine
met Thoracophague
craniophagen

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 fm
g

_w
ala
Immer tommenomenis twins
777 Synd Twin to twin Transfusion synd
Anemia polycythemia sequence
Single ay Both fetal demise
Dicordant twine
cord accident

Reggaeton
fm
a non identical twins fraternal twins

eggs g
1 in 60 so pregnancies
1g of
f
S 2 S 2
f onecycle 2
2 melee Legge a
superfecundityme
superfetation

_w
one egg fertilized implant me in
animals

ala
next month she ovulate
while being pregnant
g
Dizygotic twine are always
Di chorionic 5 2
Obstetrically safe
Di amnion

i Di chorionic
obstetricallysate always seen in Dizygotic twins
p amnion 4 But also in 307 in monozygotic

598
Shonan Shin sang
lambda sign
sugfay Di Di twins

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g

_w
ala
Problems common for DC DA MCD a Twine
anemia
T Abortion DM
T Pre Term labour flew in Preg
pple thonoamnionitie
APH PROM
Placentaprevia Puerperal sepsis
Abruption

fm
g
presentation me both are lephalic
and me a 1stcephalic 2nd Breech

_w
Time and type af Delivery

ala
monochosionis twine Delivery 336 wks by C section
Di chorionic twins t at Hrm do delivery

joji 83 x 69 xxx triploides

iggyFEI foral degeneration ay

Nonviable Placenta
fetus e aborts by 12 to16coke
2 Ut choriocarcinoma
of
scalloping villi
of
Emptyoocyte
Bothx'chr
indodup 46 xx
923x g cation are paternal
in origin
Total degeneration
of makes vesiculo mole
villi t
8
2 snowstorm app in Usa
Page no: 77
 fm
g

_w
ala
No fetus
a Diffuse degeneration of Hilli
upto sot chance of choriocarcinoma
symatome
Partial mole Present as missed abortion
Complete mole I dit high Hca Hypereonesis
Thera lentin cyst
Hca Is it thyrotoxicosis
1

fm
sine of cetines more than P O G

g
ml presentation P u Bleed

Rarely Passage of grape like vesicles

Early onset HIN in preg

_w
ala
i at Diagnosis of v mole
if HCG 7 105 I U t Risk of
if The la feat in cyst o choriocarcinoma
if uterus is large

Re suction Evacuation under oxytocin infusion

After tweet
4 cheek curettage to rule out retained bite
ex r s wing is me metastatic site
Hca titre t follow up tool
Do weekly one fill negative
7 weeks partial mole
9 weeks complete mole

after thatdo monthly for at least Gmonthe

no pregnancy month ideal eyear
4 give contraceptives

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_w
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BenignTrophoblastic Gestational enrophoblastic
condition neoplasms

p gg tTk
Normalpreg Ignites sx
Clt

vesicular
mods Persistante Of
choriocarcinoma
205 Phoblast'stissue Ifollowup is byHca

Abortion Best RTs chemotherapy

fm
methotrexate

g
placental site loophoblasticTo
follow up is byHCL R Sx

_w
choriocarcinoma

ala
t t t
preq Abortion v mole
It It 201
4 worst prognosis choriocarcinoma

staging of morocarcinoma
stage I limited to uterus
stage I Pelvis
stage III lunge
stage II distant metastasis

low risk C7 Score

High Risk 37 score

stage I I
always low risk
stage Iv e
always high Risk
stage I we say
high risk or low Risk
Stage It
Js based on who score

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Hyperon In frequency
Gestational Hen chronic Hen
BP S 140190 Essential Hen
20 coke in Renal Art stenosis
apreviously pheochromocytoma
noumotensive 9

fm
Protienusia pre Eclampsia
300mg 24hr
in urine
syndrome
PET pill g

_w
4 Terminate the

ala
t
preg
Renal failure HELP
Hepatic failure Dlc
cerebral Thrombal Death
cortical sinus thrombosis

Imminent Eclampsia R ng sont abetelol

stage of seu worsening men spraying
Induce labor a
deliver baby
Etiology
Dlt poor placentation
20 placentation normally occurs after soaks
Blood vessels become dilated in placenta

if this is inadequate
all Vasospasm occurs
of
mother increases BP to t pathology
overcome this vasospasm
in placenta
Page no: so
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g

_w
ala
High BP
Kidney Glomeruli Reephere a Profienuria
in liver Acinar damage a Poor CFT
T Enzymes
subcapsular hematoma
in Brain Release Glutamate convulsion
ay
excitatory Neurotransmitter

Blood Hemolysis I schistocytee

fm
Burr cells

g
T in LDH

P in primigranida t in vasodilators

_w
Grand multiparous Nitric oxide

ala
Twins molar prig prostacyclin Paez
Anemia malnutrition
women T in vasoconstrictors
smoking
Angiotensin
Thromboxane Az
d in PG Iz Thromboxane Az Ratio Adrenaline
also t in S Fone TK I
s
Endoglin

steps to prevent gestational teen

Omega II fatty acids fish oil
low dose aspirin 75mg On
labium supplementation

B ay HEN in Preg
Tab Labetelot DOC Lf Blocker 100 200mg Tip
upto 2400mg day

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 fm
g

_w
ala
Tab methyldopa Previous Doc centrally acting anti Hen
if is a prodrug converts to a methyl norepinephrine
250mg 500mg Q ID
SIF Drowsiness Deppression
4 False negative IIe

Tab Nitedepine Ca channel Blocker 5 to long TID

upto song day
fm
g
Not sublingual

Tab Prazosin a Blocker 2.5mg to 5mg OD

_w
ala
lab Hydralarine Arteriolar Dilators
t after load on Heart

contraindicated drugs
All inhibitors Hypo calvaria
Renal agenesis oligoamnios
109R
f Blocker Ivar
Fares imide Ivar Because pathology is vasopressin

MT
6ft Ig oy I u Im regime PRITCHARD REGIME
Ugm IN 48ms ie loading
m dose
Ogre
continue mgs
Do termination
5gm em gym ay pregnancy
fid ay hrs most definitive my af Eclampsia
passed after BP is normal E in 1 ok in aof pts
delivery
Page no: 82
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g

_w
ala
mgsoy Renal excretion
0 0 7100mi fans
central suppressant
RR 19min
kneejeske should be present

These 3 decides the next dose

of mgson

fm
First sign of mysoy toxicity knee Jerk suppression

Therapeutic dose 4 7 megg L

if 8 to meg L t knee Jerk suppression

_w
if 715 Meg L t Resp Arrest

ala
if 725 meg L s cardia Arrest

Antidote for mysoy Calcium gluconate

l gm some 10min I V
given
DOC for t BP here 4 I v labetelol 20mg
I 10 20min
upto 220mg 20mg
d
can be
I V 40mg
given f
song

Page no:
83
 fm
g

_w
ala
Rabkin pregnancy
Gestational diabetes no anomalies overt D m
Blood sugars are high preexisting D m
first time after awoke 1st trimester highsugars
T anomalies
pregnancy
I
felt insulin Resistance DO Mba C C 6.5
dlf tepee causing FBS C 92

fm
destruction
of insulin
Screening for a Dm is done g
for all preg 24 wks by

_w
Glucose Tolerance Test Gt.tl

ala
I step 9.7.7 I 759m glucose
FBS C 92 mg t
75 gm load
after 1hr also mga
2hr C 153mg t
any 1 Abn value Gpm diagnosis

maternal problems
a
large baby t t PPA t c section
Forceps evacuation
P shoulder dystocia
Re supra pubic pressure
Me Roberta maneuver
flexion rip 7900
af
Reposit Head back
into the pelvis and
do s section
Zaranellis Restitution
Page no: Sy
 fm
g

_w
ala
M AP H
T alw Pill
Pre term labor
Abortion
puerperal sepsis
a sudden IND at term

problems newborn
of
hypoglycemia
fm
Hypo callemia
Hypo magneremia g
polycythemia

_w
Anomalies not in G Dm

ala
me
group cardiac t me a specific 2
IMI SD PDA
structural defect Aneniephaly
spina bifida
facial cleft
swallowing detect
Eso Duo atresia
Abd wall defects
omphalosele
sacral agenesis a specific
defect
R ofdiabetes
1st R medical Nutrition Diet woman
20kcal kg day if uncontrolled DM 35 40kcal kg day
24kcal kg day if controlled DM 507 by carbs
sugar charting 301 by protion
FBS 100mg t Lot by fate
PPBS C 120mg f
if 120mgt give insulin
Page no: 85
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g

_w
ala
Funded Exam to rule out
Retinopathy
Drugs
DOC T Insulin
Approved OHA 1 Metformin aka
GLYBURIDE Alibeudamide

Fetal surviellance

fm
4 Termination
of pregnancy in DM
g
in GDM well controlled on Diet I 39 wks
Diabetes controlled on insulin t 337 coke
Diabetes uncontrolled on insulin t 334 coke

_w
dsYÉÉ
é risk
p'regnancia
HIM Ivar
ala
but more
twins
for those
Fever
high DM

Antepartum fetal surveillance

Fetal Heart rate Hr by stethoscope
or pinard's fetal stethoscope

Daily fetal movement count Demo

done by mother t if 710 day
Healthy title
Non stress test rise Pinardi fetal
Symp vs para sym Nervous sye stethoscope
can be done after 28 weeks
usually done once a week for pregnancies
twice a week for high risk prey
Daily for uncontrolled Dm
FAR 120 160
5100
fetal distress
pro
Page no: 86
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_w
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160
150 31551C I 3 2 movements
20min observation
Ijmittthmmorthm in
in Furby is Beate lasting
120 t t for more than 15seconds
FM FM

Biophysical profile BPP

fm
MST 2

g
tosafetatiatingtowaramann
Fetal tone 2

_w
Amniotic fluid index 2

ala
10 10 perfect BPP
8 10
ACleptable BPP
f 6110 Deliver

modified BPP I NST ta FI

AFI is the sum of 4 liquor flyker pockets
3 3

guy
Normal polyhudramnios
oligo
ae 10 15 5 M 7,25am
amount 1000Mt 1500Mt 72000Mt
singlepocket H 21m 72cm
AmnionNodosum need
IVAR Abdwaudefects

IfomAnomalies swallowingdetects
Renal
ifgauetu Page no: 97
 fm
g

_w
ala
liquor dynamics 3,2 36 weeks
1000Mt

Lori 140014
Goon

External cephalic version is

fm fetus
best done at 36 coke because

andguterus
liquor is Reducing is bigger
and heavier is relaxed

_w
Rappler velamen of umbilical art uterine art ele

ala
eg Umbilical Art

in ar
Diastolic
nothing
1stsign of fetalcompromise

11
absent of Diastole'sflow
7.1
Reverse diastolic flow
sell compromise if fetus 328 why
Doearly delivery 1 2days do c s

Enrapaum fetal monitoring

Fetal heart Rate by steth by pinard
By doppler
Fetal scalp blood pie estimation
if pH c 7.2 acidosis
Page no: 88
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g

_w
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lardiotocography Cea
mostly E me
Variable discoloration HR recovers
umbilical cord compression E
in 30sec
FMR Mr
FETE
again.ae
fmg
IEt lateftype
athelaitation 2Xnoformal

_w
safest decielaration
Head compression Placental insufficiency

stagey Labor ala

I stage of pain
onset of contraction to full cervical dilatation
I Stage of Delivery
From full dilatation to fetal expulsion

II Placental Delivery controlled cord traction

Andrew'stechnique
II Observation for ppl y
n'ftp.dt
p

Puk 902 88
509 Lian
I stage
Page no: 89
 fm
g

_w
ala
Graph by Dr Friedman Graph

8
t

j
www.pwnneggjfjf
I
fm
g
d
0Wh
y possible

_w
Active second
1ststage labor

ala
of

Eittinguariiiation usually 3 hour can last canstop

if req
strength of 20 Miu units upto 8 hour like in
lasting 20 sect luhrs in multi preterm
prolonged labor
U in 20min 38 in fomin 2ohm in prime

Auteur 39cm
strong regular contractions a 6 hrs multi an notstop
fasting 45sec 100 mine units G f hrs prim
3 in 10min to 5 in to min Max 12 hrs
5 in 10min Tachysystole

dialed
Finding they
prolonged
N 60min psimi 2hr

Page no:
90
 fm
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I Assess cervical effacement consistency Dilation
position a station of Head

Inlet as
pl
fm
Ei
g

_w
ala
II D

Os closed us open Bem

Had est Head t 1st

FE when station is at
E and below then
t 2
the broadest part of the fetus has gone
through the narrowest part of the pelvic
i channel is best
af delivery
forceps and valcum in modern obstetrics is

always 2 Ey below station

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g

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i Prevequisition for forceps and vaccum
FORCEPS vaceum
Station 2 9 Below 29 Below
Cx fully dilated 76cm will do
Head should can be non
becompletely rotated also
rotated
straight
fm
membranes absent membranes absent

g
good contractions good contraction

Indications

_w
Problems in power mom can't push

ala
passage Narrow pelvis
passenger Big baby

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 fm
g

_w
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Engagement of Head
when I 215th of Head is palpable pla

5 3 454
fm
g
Diagonal conjugate is the only
measurable conjugate
DC 12 Im

_w
Obstisbis conjugate De 2

ala
10cm
True conjugate Anatomical
conjugate De I Clem

part of the fetal in the lower segment

Playfair Breech shoulder
me malpresentation

labor Deliver Deliver

G
No Delivery
institutional setup c section
under experienced
Doctor
36Week f 7 ECU Ecu
relaxed Page no: 93
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g

_w
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Renting Patt part of the presentation on the int Os
in cephalic presentation this depends upon the
attitude of the head

Attitude presentingpart lowest Bone Diamine Delivery

flexed vertex occiput 5013 9.5

Extended Face mentum 5m13 9 t

fm
Deflexed Brow Glabella mentovertex X

g
military Mcm cs

_w
Position the presenting part
of

ala
Depends upon the location of Denominator of pelvis
i me presting pants vertex depends upon occiput in pelvic
M1 position of vertex LOT LOA

me presentation cephalic me malpresentation

f Breech
Me presenting part vertex me position Lot coat

In 1079 LOA Diament 9.5 Delivery

of Engagement
me malposition Rop

Gynecoid 807 ROP Rotates to O A Del is possible

Anthropoid 15 161 Rotate to O P G becomes PoP 2
4 Rotation to OA is not possible Delivery by F 7 p
Android 2 47 ROP Rotate to G t if seen in time
MR FE
if neglected Deep transverse arrest cs

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 fm
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2nd me
stays POP
TOP Delivers a fate to pubis

Rotates party
me
FREE

fm if Neglected Dea

pop g pop
et
1 T

_w
Rotationpossible

ala
to O Ant
o Ant
Delivery by Fare p past SMB 9.5
Delivery possible in
mentoanterior
MC LMA Delivers

T Rave

Piggies after can be assessed by pelvic examination

only in 2 hours in active labour
aim 1 im dilatation hourly is expected
1 im descent in active labour

Plot this portogram f

on is ka the best
assessment of progress in labour

Page no: 95
 fm
g

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Partogram
It prolonged labor
I PPH
I Puerperal sepsis
s d neonatal morbidity a mortality
t maternal morbidity
In forme when to convert to c s

fm
g
Edna mcement oftener

_w
ala
c Engagement
2 Descent
3 Flexion
4 Internal Rotation pelvic floor
5 Delivery by extension
6 Restitution correction
of IR
7 External Rotation Rotation
at pelvic floor
of shoulder

Page no:
96
 fm
g

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ala
ntd.tivmmead
FIgamggn.to
or smooth Irregular Breech
II lateral Back limbs
grip af
II facing mothers fate 1stpelvicgrip
paulick
fm
Breech cephalic

g
if ballotable its head

E Facing mothers feet 2ndpelvicgrip

_w
Breech cephalic Paulick

ala
engaged unengaged
e Flexed Deflexed extended
or
most informative
Breech

Flexed extended 9 extendedhead

completeBreech Frank Breech Incomplete stargazingsign
Delivery Mk Breen Breton Do c s
Best forvaginal Do as u

Delivery
IEEE

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 fm
g

_w
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Bleeding
Abnormal uterine bleeding patterns v
causes AUB PALM COEIN
of

fm
g

_w
9,15955 7 5 ala
me vasodilator uterine ear
Tranexemis acid fantifibrinolytic
Bleeding
inhibits
Fibrin
plug
Fibrinolysis plasminogen

Rebleeding activator

next line Hormones

Progesterone of Endometrium
stabilization
Estrogen New endometrium replaces old
bleeding endometrium
Coop low amount artificial periods
Androgen Atrophy
GnRHa Atrophy
Progesterone IOCD Atrophy
do
mirin a Page no:
98
 fm
g

_w
ala
If nothing works a
surgical Mx
surgical my affaire Bleeding
Dgc Therapeutic curettage
uterine artery embolisation by Pua particles
Endometrial Ablation
Balloon thermal Ablation permanent amenorrhea
microwave done in 740gv age
Hysterectomy
fm
QQ PG
older method of endometrial g
ablation Dere

_w
ala
IEermeaagenomenalablton
Balloon Heating

Intrauterine instillation af heated saline

endometrial laser intrauterine thermal therapy
Global 3D Ablation

Punctual vaporation

Photodynamic endometrial Ablation

microwave endometrial ablation

Radio frequency and cryotherapy

Page no:
99
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g

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ala
Eec flowage mmr 97
mic
of maternal mortality in India d
Abortion placenta previa
Antepartum H'get Abortion
Vasa previa
n
postpartum age

PPI any significant Bleeding

fm genital tract
in the

g
after
delivery
Definition significant is tooo ml after delivery
Previously Normal Delivery soon

_w
cesarean Delivery tooo me

ala
10PPH Bleeding t in 24 hrs of delivery
20PPH 2h hrs to 12 weeks retained bite

Endemental If RPI livingligatures miss crose arrangement

ÉI
DiDi

Renting PPI active my ay

3rd
stage of labor

1 Ing Oxytocin 1x 5 10 Iv to the mom when

ant fetal shoulder delivers

Page no: 100

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g

_w
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2 Delayed cord damping Go see
this P Neonatal Hb by 1
gmt
4 contraindicated in Torch
fetal distress mice HepB
No antenatal transmission
HIV tee mother onlyduring Peripartumperiod
Hbs Ag ve mother
Rh ve mother

fm
3 Control cord traction
g
u Uterine massage

_w
ala
Rey PPI
actor prevention at n

iii
s
Doc for treatment of pple oxytocin IV infusion of 201 U
Excess oxytocin acts like ADH
a
CARBETOCIN loong Iml I U over 1 min
given
synthetic analouge of oxytocin more sustained action
93 4 hrs
Methylergo me kine 0.2mg Ing slow Iv acts in 90sec
le CII in Im also
Rh ve preg
HIM in prig
Cardiac disease
Before second twin when baby is inside

Total dose in 24 hrs is 5 injection ing

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g

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Tab MISOPROSTOL PGE 1
orally 200 Mcg
or Rectal 800 1000
meg
8 injections
Ing CARBOPROST 250 Mcg 1 m only Max 2mg in 24hrs7
4 Go to Drug l V causes sudden Hen

Ing tranexemic acid igm

fm
IN

Activated Factor VII I U g

_w
Balloon Tamponade

ala
BAKRI BALLOON
500mi Ns is used to
inflate

BRACE SUTURES B Lynch

compression

Uterine Art Embolization

uterine Art ligation

steps of uterine
ovarian art ligation devalcularisation

Int Iliac art ligation

hysterectomy

Page no: 102

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g

_w
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Mag n
to an decade
Mcc t abnormal conduct labour
of
Early bearing down
Prolonged second stage
Head is at pelvis floor
6 levator Ani Damage
faulty
fm
instrument

g
ft Gap btw deliveries
multi parity
also Ascites Abdominal masses chronic cough

_w
ala
Classification Pubic
organ prolapse Quantification system
POP Q

Symptoms
Urinary
Retention
Infection
stress incontinence coughing
Intges

of stood

Page no: 103

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g

_w
ala
Temporary releif by pessary R
It is adequate if on straining the uterus
doesnot come outside and there is no

pain

MB clean pesseray daily

surgery
fm floor repair
Ward g
older pt vaginal hysterectomy pelvis
a mayo's repair

_w
young it Tighten the ligament Pelvis floor repair

ala
Fothergif Repair

multiparous woman sling surgery abdominal cericopexy

tied to sacrum Shirodkar
tied to Asis Khanna's

t fi ed to Rectus sheath Purandar'd

Antepatum Hemorrhage
Bleeding in pregnancy before delivery 28Wh

cause vara previa in all 3

Abruptioplaienta No towlyties are
Placenta prey a given dit Risk af
PT Bleeding
Page no: 104
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g

_w
ala
Renta Prestia placenta at Door

Definition Totallycovering os partly covering Os

PK
is i in
Pi intros
low lying placenta placenta 2cm
of
fm
g
E
_w
ala
Incident I in 300 400 pregnancies
4 alw
large placenta twin
two placenta
placenta accreta
previous uterine surgeries
SCS D E c myomectomy

symptom mostly does not Bleed

6 if at all they bleed painless bleeding

1st my Resuscitate
NO pelvic examination

Plaienta previa bleeding Terms c s

Placenta previa terms
if totally covering the Os t do c s
partly covering Examine in or under anesthesia
4 Double setup Exam
0.7 E CR
Page no: 105
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g

_w
ala
SHE
moved away still covering

pot as
fm
sand to ur

Placenta Previa Bleeding C 34 weeksg lung immature

resuscitation

_w
Rest goy cases Bleeding stops

ala
sedation Mcaffee Johnson Regime
steroids contra indicated in Dead fetus
severe anomalies
mother is serious
Of Cases Blending continue
4 Do CS

NB NO 70colytics Risk
of 4 Bleeding
t

Emit.IE tgt ndsottreg'I'm.ca an

associated me i men in preg
Also Twin gestation
poly hydvamnios
Drug addict
smokers

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g

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ala
concealed Bleeding
Revealed Bleeding
Bruising in uterine muscle conclaire

SIBI
painful Bleeding
gpa
I Diagnosed after Delivery
IT Diagnosed During labor
TI Diagnosed Before labor worst

fm
may have fetal death

g
DIC
Re Resuscitate Control BP

_w
Abruption term X s e s
I

ala
Fetal diewere
HR 100 pH 7.2
Arm oxytocin On Delivery
artificial rupture of membranes
t
a ft uterine volume e causes compressionay placenta
and the Bleeding
Release of local pal e indules labor

AM.PL he34wekim I immature lunge

resuscitation No conservation my
steroids t
a tissue thromboplastin
because retroplacental clot triggers
Extrinsic coagulation cascade
R Arm oxytocin t
consumption of clotting factor
Tony's No 4 PIC I Die
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 fm
g

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ala
Common Iliac Art

I
peep circumt Supglutealart
Int Iliac Art

i
Infy fm
Epigastril
In Era g
1

_w
Femoral vesicle
sup Art

ala
obturator art d
uterine Art d
Inf vesicleArt
Middle Rectal Art

Inf gluteal Art

Int Pudendal Art

mnemonic Iliolumbar
Branches of post division
Jap Fugatelat sacral

only Anterior division is ligated strong enough to

reduce the flow But not to stop
This sluggish flow promoter thrombus in the
uterine bed Bleeding stops

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g

_w
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mood of placental Emery
C C T by B A T method of choice
Crider method vigorous squeezing of funded
to forcibly separate the placenta
STE A pain
Retained placental Bits

fm20
Retained placenta t Retained placental Bit

Reg
No placenta da PP H
even 30min curettage
As hermann synd
of fetal del Sle

_w
ala
under a A
T do manual Removal
of platen ta MRP
If while doing placental delivery
4 sudden cord traction is
given
4 Inversion of uterus
sudden pain Neurogenic shock
excessive Bleeding Hemorrhagei shock
me COD
predisposing cause
fundat placentation
multiparty
Delivery by untrained people
Re Reposition
under GA
Relax cetera by to colytice terbutaline
Reposit uterus
give oxytocin to contract the uterus
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 fm
g

_w
ala
that method best method
Hydrostatic use fluids to fill the vagina aka O'Sullivan'smethod
Surgical Huntington method a traumatic clampsthroughabd
Haultian method a resectionof constricting Bande

Signs of Placental separation

fm
Permanent lengthening of cord

g placental separation
Fresh Bleeding
supra pubic bulge surest sign of

_w
method of placental separation

ala

central separation marginal separation

Shultz separation'm Duncane separation
6 membranes seen cotyledons seen
first first
Bleed more

TYPING
Pggthly yeen left vien left behind
2 Arteries
length 50 60cm
short cord c 20cm
long cord 300cm

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g

_w
ala
Hemochorial
cord attached to placental centre
G splits into vessels

Battle dove Placenta

marginal insertion
can get detached while doing
fm
placental delivery
g
succenturiate lobe
Accessory lobe

_w
I can stay back after placental

ala
delivery
20 ppH R curettage
S E As herman synd

circumvallate placenta
chorion is smaller than the Amnion
É8fhy a hence the amnion is folded around

Magweifarterence of placenta

Abruption
Pre Term labour

Yellomentous cord
cord splits before entering the
placental margin
I Rarely this may present on the internal o s

yasaprevia pain Bleeding

f but this
fetal bleed
is
507 case fatal
if diagnosed in times doimmediate e s
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 fm
g

_w
ala
70 distinguish btw fetal Blood a maternal Blood
Qualitative
API fest f NaOH
vaginal Fetal RBC stays red
Blood I resists
alkaline Denaturation Hb
of
i RB I becomes colourless
maternal RBC

fm
TO g
jpg labor in preterm labor

_w
But before 34 coke TO achieve lung maturity

ala
9 3cm dilatation

Dregs
Doc Nifedepine CCB cart channel Blocker
30mg stat orally 10mg 7 I D
least palm Edema in compassion to
other drugs
i good even in Heart DS T PTL

my soy 1 2 gm 1 x hour
only neuroprotective fococytic
Cat cerebral palsy
S E Neonatal Hypotonia

f Blocker salbutamol Terbataline

Ritodrine Isoxsuprine
SE T Tachycardia 82 Q
Pulmonary Edema

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g

_w
ala
PG synthetase Inhibitors NSAIDs
Indomethacin 75mg sustained
release 1 day
But not given 732 wks
can cause premature
closure of PD A

Progesterone safest tocolytic

fm
smooth muscle relaxant

g
6 move used as prophylaxis than Re

Nitric oxide Nitroglycerine patch

_w
4 smooth muscle relaxant

ala
Atosiban oxytocin antagonist
6 wing maturity fetus
of
Neonatal morbidity mortality Fenefif
6 Tocolyh's effect

Diagnose af Petrmlabor
a contraction in 20 8 contraction in 60
ptu Os is z 1am dilated
Sot Effaced

36 37 wks late preterm labor

32 34 Wks Preterm labor usuallyencountered
28 32 Wks Early preterm labor

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g

_w
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Prediction labor
of pretermcoke
Usa around 12 shoot Cx c 2.5cm
uterine anomalies unicornuate

4septate
Bicornuate

around 28 wks t ex showingfunneling of membranes

IT shaped 1st sign t Y shaped
Just Before delivery t o shaped

fm before
Also Presence
of fetal fibronectin FIN

g
in the vaginal secretions 370k
Causes
anatomical causes short a

_w
uterine anamolies

ala
over distended uterus Twins
Polyhydromnios
large baby
conditions like DM
infections Chosioamnionitis
071
Peritonitis em
Uteroplacental insufficiency

Accelarate king maturity

steroids
Both Fog Dexamethasone 6mg 12hourly u doses
are f Ing Beta methadone
young
12mg In hourly 2 doses totally
Equally effective
if Baby is born premature immature lung
t
artificial surfactant
Survanta given Endotracheal
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114
 fm
g

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ala
Roimmanization
Rh Ag is present on Chr 1
Ifhas 5Antigen CC DEE
Dag is most antigenic
i Rh Ag Dag
B A
B

fm
B
vet of ve AB vet
g o ve

mom rn ve Father Ratve

_w
UH I late

ala
offspring
I
Rhtve in 501 to roof case
Depending upon the zygosity

If mom and Dad

A ve At ve

mixing of Blood mi delivery g to some

Fetomaternal Hge
also time of Abortion
Ectopic
Molar
Amniocentesis
Cusamplinge
Cordocentisis
Abruption
Pl previa
when mom gets contaminated by RhAg Dag from
fetus
mom makes anti Rh Ab aka Anti D
GThese Anti D will destroy all fatal RBCs

Page no: 115

 fm
in mom's circulation carrying Dag
g

_w
ala
However the first child mostly survives
1
Next pregnancy this mother is waded e anti Dab
I
These Anti Dab will reach fetal circulation

if fetus is rn the mom's Anti D will cause

Ag Ab Reaction on fetal RBC
Hydrops fetalis t
pleural effusion Hemolysis
fmJmemia
g
jaundice
pericardial effusion
Ascites
Edema

_w
can even be fatal

ala
in response to hemolysis the fetus
responds by making a hyperresponsive bone marrow
Erythroblastosis fetalis

To prevent this Give Anti D to mother when she delivers

Give 300 Mcg Anti D T in 3days Neutralized 30Mt fetal Blood

I 15 ml fetalBlood
some benefits upto y weeks
if abortion 12014 t 50 120 Mig I m
or ectopic 12 coke 300 Mcg I m

Better t find out Exact amount of Fetometernallige

Quantitative
test
by Kleichaxer Betke Test KBfest
Acid Electiontest
mom's Blood f Acid wash
co citrated Buffer
O O 060
Redthucleated RBCs fetalBlood
flutes the Hb from RBC Resist
6 RBCbecomes colourless
maternal Page no: 116
 fm
g

if fetal maternal H'ge some

_w
is

ala
t
give 2 Ings anti DAD
of 300mcg
In pregnancy
mom A ve Dad Atve
at diagnosis of pregnancy Do indirect comb'stest
ICT
informs about the Antibodies
If IIT is ve means that this mom is not

f
Iso immunised
t m
continuepregnancy g
DO I 9T at 20colas Ice ve
I

_w
24 wks Ice ve qophylaxis

ala
mm c
32 wks Ict ve

40 wks I Deliver check fetal Bloodgroup

if fetus rn the Do KB fest
giveappropriate Anti D dose

Prophylactic Anti D Regime 300 meg IM

at 28 weeks
at Delivery
Hydrops Rh Iso immunization
NIH
Mec Non Immune Hydrops
1 mil congenital Heart Block
sardia mi
moi chromosomal
Ms infection cause a Parvovirus B 19 infection
Hematological came a Thalassemia t He Bart
metabolic
Genitourinary t Posterior urethral valve
Renal causes Polycystickidney Ds
cystic hygroma
Page no:
117
 fm
g

_w
ala
TUbl.fm Igtenciration
permanent
Irreversible
Sy is required if re anastomosis is requested

mi fubectomy postpartum puerperal sterilization

Best time is first 2 3daye offer Delivery

fm
can do up to 7 10days

g
But after 2 3 weeks uterus is a pelvisorgan
4 Interval sterilization
Entry laparoscopic

_w
ex

ala
laparotomy mini lap 1.5 to 2 inches
sin
ayligation Isthmus is the mic
Because isthe mo
Re anastomosis is upto

jF
801 successful
Étemur

Techniques mi e Pomeroy modified

leet ends are together

Ah may have spontaneous Reanaltomosis

Ewings Bury the tube her imbrium

Éjmensapin

Page no:
 fm
g

_w
ala
mad
ILL
e
loner's crushing only
A failure Rate

Laparoscopic
Rings Fallope Ringe Silastic
clips
material
Fine wtia
fm
lauterisation g
Best re anastomosis laparoscopic clips
worst re anastomosis

_w
I instrument to hold Babcock

ala
me
wrong ligated Round Cig
Small Bowel
Appendix
ovarian lip
ureter never

Fs sure coil Nitin ol Nickel titanium alloy

I flystereoscopic application
works by causing fibrosis in 3 months
of tube
t

E Hence Block use alternate

contraception
1 after 3m on the
cheek for the tubal Block by HSG

FEE

Page no: 119

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g

_w
ala
Vasectomy
2 Rs 200 motivator
Rs 1300
given I Rs decor patient

Non scalpel vasectomy Nsu

Sharp artery stab scrotum reversibility
30 357
Reing for leper told Val

fm
SE Hematoma

g
infection
spermatic cyst
antisperm antibodies

_w
Because damage
of

ala
in Blood testis barrier
Erectile dysfunction
loss of libido
loss of strength
Blindness
cancers
speech defect

speed sedans
Vesicular mole NO I bed cause perforation
give cop

Heart Dis No P no pop

co Fluid retention
Give IUCD

PM Both IU ID a cop are Ideal

in controlled DM
Page no: 120
 fm
g

_w
ala
uncontrolled DM 4 Barriers t spermicidal Jelly

HIV STD Barriers t spermicidal Jelly

Newly married couple Coop

Couples in separation cities t IUCD

lactation amenorrhea fPOP

mg
Post placental Iver

_w
Iver after stage III

ala
expulsion is only 12

Page no: 121