OBGYN

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

Day afterfertilization 39-40wky +

6dayB Anomaly targetscan-18-20 why
:

zygote (Morula)
1-3 8-16 celled Placental 3rd trimester
>
-
localization ->
Day >
-
Blastocyst
y
formation .

scan
Day Implantation.
Areuploidy (Donis) C
6-10 -
>
if >, 3 mm >
- &It ,

STPAL System G Total .

of times concieved
forTTS
* : : no
marker
Early
*

*Cystic Hygromsa b c
·

(Twins 1)
-
-
=

Next s
T: No
of Term deliveries (73Twks)
Aneuploidy
.
.

P: No .

of Pre-Term deliveries (20-36 -(4)

① Karyotyping/FISH
A: ⑧ Fetal Echo
No-
of abortion (< 201KD)
L :
No-of living children (twinp 2) =

* Estimation of Gestational
Age
:

(used Will days) CRL < 84mm

T

, >
- CRL 11 WRB + or

+ &montha
* DD :
day of LMP + +
Tdays CRL in mm + 42 =

Gest Age
. in
days.
1 Tdays 9months.
day of LMP + BPD > HC
if Feb TL-
>
-
+

Expected EDD :
Presumptive EDD +
(Cycle length-28) i - FL + BPD + HC
[Single Best =
FL]
For Date
of oocyte
retrieval + 256 days (Fresh)
yelex
Abdominal Circumferent
IVF :
Fetal Growth by USG
.

* Estimation of >
-

Date
Frozen cycle >
-
Dz transfer =
of Dz transfer + 263
Hockey
>
- Stick
Sign (Portal Sinus
Umbilical vein
Ds tranfer = Date
of Ds travefor + 261 stomach is visibile)

USG (Crown Length) of Weight

Estimation
For irregular cycles >
- Rump *

Best >
- Johnson formula

USE -
Hadlock/Shephard formula
*
Signs of pregnancy :·
Best A
Single
6
Goodell's Soft
>
- carvin
wks
Chadwick
-> Blue colour
Vag 8 wky # Macrosomia
-
-
Weight of Jetux >
,
4
kg
Osiander >
- Lateral
Vogwall pulsation 8 WKX RIF Post term pregnancy
Diabetic Mother
-
Dr : Al >, 35 cm on

USS
Palmer Uterine Contract
>
-
Rhythmic 8
why Male Fetus MOD :
Vaginal
Maternal
Pisakeck Uterus ↑ Obesity C-section >
- In diabetic mother we n
Sky
Unequal
.

>
- 8 wky Non diabetic mother
,
of y, 5
by
Hegar >
- soft isthmus
6-10
why
I
Placental
Hartman:
>
-
Bleeding on
implantation

*
Height of uterus decreases by I finger breath) day
24 try
after delivery
.
Intradecidual Double Decidual Double Bleb
Sign
- first movementfelt
Sac
Sign Sign
quickening
->
fetal
in
primigravida
>
- 18-20 weeks
Hockey
in 16-18 weeks
. Stick
Multigravida >
-

>
- Fetal Heart sounds ->
By doppler at 10 weeks Sign
pt
>
-
USG - Intradecidual Sign
sign on >

>
- 1st structure seen -
> Gestational Jac
 Spina Bifida Duodenal Atresia Posterior Urethral Value
Anencephaly
2 .
IOC >
- TVS 1 .
Lemon Sign 1 . Double Bubble Sign 1
.

Key Hole
Sign
IMickey
Mouse
2 .
Shower Cap Sign C .

Meningeocode 2 .
Leads to
polyhydramnios .
2 Associated with Oligo hydram
sign
.

or
3 .

↑ <FP Meningiomy local .

3
Afw Trisomy 21
.
4 Best time to detect : 14 weeks 3 .
Banana Sign
Earliest - > 10 weeks .

does not T, Abortion

# Thrombophelia cause

*
Infections can lead to Spontaneous Abortion
O S
LEscept Hv]
* Infections does not cause Recurrent
Pregnancy Loss
.

* Four Established Causes

of Recurrent Pregnancy loss Anencephaly Spina Bifida
① APLA Syndrome

(T2TTI)

8
O Uterine Structural Abnormalities

go
⑧ Chromosomal Abnormalities .

⑨ Hypothyroidism
ROL
*
Investigation for
:

antibodies
① Ultrasound ② APLA

③ TSH ④ Parental Karyotype Duodenal

Sign Key Hole Sign
# Cervical
- Incompetence
Patient -
-↓ - Patient with

Ho, 2 T2 Pregnant Female H/0 Abortion

NonPregnantd
no
Painten abortions
but
No Trim
/ - 1 is abortion

Length of Cervise is
Abortion
at
verup Preg
.

Pregnant Pregnant+ at 16
16 < 2 5 cm. -

↓ 8 weeks weeks
Cervical length ↓ ↓
2/2
dilator
No
. 8
Hegar through
(16-c4WRD)
am

Koesteron
TVs
internal
OS/16 No
Jolly
↓
·

C
with 1ml water
catheter No
investigation
pull out .

if Length >2 .
5 cm +
Progesterone
to if Length 12 . 5 cm >
-

Progesterone
Mogesterone
t ↑

LASH + Cervical
Vaginal
>
-
LASHG Cervical
Cercelage
:

Abdominal -
>
Laproscopic
correlage
. 4-
14 WRs) cerlage
-

12-14 was Types of Abdominal Coreslaye

* Time to apply Satures >
- *

Pregnancy 2/1 Durfee Lapposcopic

3 months
* After LASHGLASH SX -- is for . Bensen , ,

Never done in Pregnant females

.
#
Oligo hydramnios # Polyhydramniop #
PALENTA
-

① AFI < 5 cmy ① AF1 :

7 25cmy
,
at which
② Sup < Cem
② Sup y, som Gestational age

Fetal not
M/C Renal Anomalies not
of placenta
=
in Tz >
-
M/Cause of Severe
Poly -
>
GITAnomalies
.

UPI/ PROM
is
M/( in Tz >
-
2ndm/<Cause Tube
>
- Neural
Defects weeks
My of Severe
Oligo :
Congenital Renal Abdominal * Maternal side
ip formed by
Anomalies
* E
defects *
Decidea Basalis
& Duodenal Atresia : Omphalocels
M
: Severe
Oligo/Polyhydraming =
Esophageal Atresia ) Gastrochipiy
* Fetal Side is formed by
↓ Obstruction
: Intestinal
Chorion Frondosum

use = Cleft Lip/Palate * Human Placenta is

-
Normal Congenital Anomaly TORCH also lead to Avoid Deciduate motorial
↓ ↓
*
infections Can

Pls enam
Karyotyping Oligo 7 Poly in T2 *
Afformones Secreted
:

t
Colour Doppler
* Indomethacin is used to treat
1) HCG 1) HOL 11) Progesterom
iv) Estriol (E3)
# Complications Polyhydramis ,
but should not
Early 14
Life Placeta -
>
LUA
RUA

32 weeks. Vessels
T2 >
-
Pulmonary Hypoplasia
be
given after LUV

Limb reduction ↓ Later Placata Venes

RUV

* Can lead to Premature

Potter's Syndrome - RUA LUA LaV
Closure
of ductuy Arteriosus. , ,

T2 -
> Lord
Compression Battledore

FMeconiumAspiration
a

*
ther Associations
H
similar to (H
.
dif Upl lUGR
① functionally
Succenturiate
:

dIt PROM : Amniotic Band ② Produced

by
:
Synctiotrophoblast -

Syndrome
z
Blood
③ App in : 8-9 days ofFertilization
.

Digital Amputation
Phocomelia is increased in
* In *
H24
Proximal Limb Amputation Bilobata
>
- Downs Jyn Placenta
- -
is seen
d/t injection >
- Twin
Pregnancy
o ALIDOMIDE - Molar
-
Pregnancy
-> Gestational Trophoblastic Neoplasia
Per
Vaginal
.
* Examination is 6/1 in

Circumvallete
Ruptered Membranes
.
in
-
in decreased
*
HCG
>
- Abortions

>
- Ectonic
Pregnancy
Frisomies other then Circummarginate
>
- -
trisomy 21
 Oral
< wkp D. T
Milpristone 200
my
Syndra
at >
-

#LA ->
.

#
>
-
·

·
Lupus
Anticardiolipin Antibody >
- 7-12 woky -
Medical Abortion

> Suction Evacuation > Misoprost400 moae

7-9 woks
Antip 2 Glycoprotien 7 12 wk >
- Abortion
using Misoprost
·

>
- Oral
T
Mifepristone Coo my
it inhibits trophoblast Juncer
.
T
Misoprost 800
may oral/buccal
Ensure Process is complete
*
Diagnostic teria
Mod SAPPARO
.

SYDNEY Criteria
Criterial
& Clinical + 1 Lob Criteria
Thrombosis
Episode of
(Both used for Suction)
>
-
are
>, 3 losses at /10 weeks
>
-
fetal
Evacuation
losses at 7/10 weeks Vaccum
Manual
>
- > / letal ↓
* Done best between Aspiration
> >
- / Preterm delivery before 32 coke *

d/t UPI
,
(UGR eth [T-12 cors] (660mmHg)
* Lab Criteria

3 antibodies
>
-
Any one
of the + ve

on 2 occasions 12 wky apart

.

MADLANancy
Loss]ASPIRIN
No

No
Pregnancy
Thrombotic Event

2) ⑦ Pregnancy
⑦ Thrombotic Event
Loss

JASARIN
HEPARIN
Ectopic
ve n e
Pregnanu
Triad
of Pain Abdomen +
Bleeding P/V + Amenorrhea (6)
DonPregnantwith na
3)
Ruptured ruptured

I
# #

Preg.
=> Ectopic Shoulder tip Pain + 101 >
- TVs
2) Intrapartum
-> A So Prulation Urge defecate/Orthostatic
to

Hypotension .
If Finding
Medical M2
Confirm Ectopic Pry

* => PA Abdominal distension a

itfindingUnconfire
Enam :

Rebound tenderness mass

Gaurding
&
Ridgidity king of five appearance
4 inside tube
Only G Sac
PvEnam
:

=> :
Soft Uteruy, Enlarged Empty Uterus
.

but less than

POG ↓
sign Emm. 4Localizing sign ⑰ B-424 Estimation.
Localizing Stabilize Vitals Mr : Doc -
> Methotrinate

UL
salpingectomy Surgery preg.
for dctopic 50mg/m2
IM

Claprotomy/Laprosory) Surgery Salpinectory

.
:
 Highest
risk
of ectopic
pregnancy
>
- Previous 110 tubal
Sn/Ectopic Pregnancy
& Absolute Risk
MK Risk for Ectopic
:
PID) salpingitis * Contraceptives :

↑ Relative Risk
.

#MOLAREGNANCY I0 >
- Trs

Standard -
Gold > HPE
[Proliferation of trophoblast
① Complete Mole
② Partial Mole
(69XXY) Villi Present ;
Hydropic
degeneratiot
⑦ Paternal material
>
- 46XX >
-
Mer : Suction Evacuation F/B Sharp Curretage .

>
- No
Jetal tissue ⑦
>
- some
fetal parts
Pregnancy CI for 6 months

of Uterus > POC POG

>
- Het >
- Funda ht <

>
- ↑ BUCG level ( > 10 1/2) >
-
BUCG Higher:than Normal

BIL thera luteal but less than

>
-
cyst pregnancy
mole
App complete
>
- US9 : Snow Storm .

> Less chance of Conversion to

>
-
High chance of conversion -

to GTN EIN

ou
Storm
app)
#ntePartum Demorrhage
:

① Placenta Previo
② ①
:
Abruptio Vasa Previe
③ Uterine Rupture
Tz Pain
Bleeding + No Pain in Abdomen
- No pain Pain
Tz
Bleeding
>
- >
- - +

Red Coloured Blood Tz Bleeding Fetal Blood Loss

>
-
Bright - + dif & Previous 40 C-Section
Sinusodial Heart Pattern
-> Uterus Relaxed , soft ,
+
D/T PIU/PROM +

on NST
>
+
Bright
Red Colour Blood

Non-Tender Dark Red Colour

>
-
>
- Abdominal Tenderne D
>
- Fetal distress
Ht.
>
- of Uterus > POG >
- Uterus Tense + Tender
- Parts
Fetal palpable
.
- Fundal H+ > POY
102 - TVS
>
- Fetal part
Felt
Placenta Previa MoAbruptio
Mr
of Associations
with ⑦
Continue
Pregnancy
and Johnson
① DIL if fetal distress

Mcafer Regime ⑧ Preterm Labour

C-section
Termination
③ Couvelaive Uterus if fetal distrus absent

& Retro placental Clot Q POGT34wKD : Induction of

labour
6/b
Vaginal del
② POG(34 wKs : Mr Like Placate
Previe

Toclisa
 Hematological Changes in
Pregnancy
· Anemia
-
-

Mr
of IDA in T1 (Paventral
iron
(2)
Hb <
(i)
5gm/dL-
> Blood Transfusion
t

Signs of
CHF

(ii) 2167
5gm/dt-2IFA/ day
No
signe of cuf

in
Mr
of
Anemia in
El To
Cardiac Changes Pregnancy 2) if Mb >
7 gm/dL
> <34
-
cr Ira/day
7
,
34 weeks
Parentral
iron

ii)
L Hb <
7gm/dL
> Blood Transfusion
if Hb <5 -

46 btw 5-6 9
if
.

PoG134wb
Parentral iron

Pog >34 cbs

Blood
Tranfuss
# To prevent Anemia
for all

Reproductive age groups

:

+ Albendazol
IIFA pill /week
2x a
year

* Supine Hypotension Syn # My2 Heart disease : MS

⑪ Mr of Peripartum
Max Eisenmenger Sun
Mortality
Cardiomyopathy
> Seen in
- T3 * : .

>
- d/t Compression of IVC * M/C Congenital . -
H D .

ASA

Ru
left lateral pos Bromocriptive
Program
>
-
Lying
: in
is (1 in :
+
*
Methyergometrine is (1] in >
-
Pulmonary
MTN >
-
Marjan Syn ManageFalime
Heart
severe MS
NYHA Grad 3/4
during
Mr heart disease - >
of
Severe As Coarctation of Aorta
Labour
. >
-
=
LVSE <35% Peripartum Cardiomyopathy
>
- >
.
 # Syphilip
>
-

Follows Kassow if y law

>
- Not alw Recurrent Abortions
# Varicella Zoster :

weeky
Taratogenic Period > 12-20
-

*
Congenital Varicella Syndrome
Catarant
Microcephaly + +

Licatricial Skin + Limb Hypoplasia

&
Congenital
Neonatal I

#
Congenital Rubella
Heart disease + Cataract +

SNHL + Blue Muffin

Berry
Rash
-

* Indication for MTP

.

dystocia
#Shoulder
⑦ Turtle
Sign

McRobert's

# Diabetes in
Pregnancy :
Gaskinin
Diabetes
① PGDM ② Gestational 4 Maneuer
* Priscillia White Classification .

Controlled with diet

>
-
Type A, -

FBS7, 126 mg/dl Insulin Wood Cork Screw

>
-
Type Az-Controlled by
RBS Y, 200
mg/dL
2hr PP >, 200 mg/dL &: 1st 2 weeks : Diet
Control
HbAIC 716 5 %
Weight Modification
. -

*
Congenital Malformations
in
PGDM Not met - Iulish
if goals
+ >
-

Risk Assesment tool : HbIAL

insulin
>
- OHA
if patient refuse
IOC : TIFFA
>
- ONA ip 6/1 in PGDM
* Rx of PGDM (Terminationoa C >
- Terminate at 7
, 39wKD (A1) Algorith for Ra of
diet
Insulin (DOL) weight + not controled dystocia
Shoulder
-

if
themby 3a
>
-
Counselling
Low Dose Aspiri by insulin
pertension in
I
Pregnancy

#
Magnesium Sulphate
and
DOL in
preventing treatingSeizures
hypertesive pregnant jemale
in a .

>
-
Acty on Receptor
NMDA

>
- 4 -
7
meg/L
* Pitchard Regimen
* M/2Cause of Hydrops
jetalips in T2 Jean is

Turners Syndrome

>
- CIF of Hydroph Fetalis
Scalp Edema (Earliest See
in 159)
· Polyhydramnios
)
:

Placentomgaly

Tic Diamniotic

One twin with oligo

other twin with
poly
Ma : < 28 weeks in utero
-

laser ablation
of passage
728 weeks : Amniocenter
is
twin
of larger
.
Pre-Term labour

Umbilical
Normal
Antery <3
doppler
S/D ratio

in PIN - 7, 3

Uterine
Artery doppler
>
- Done at 22-24 cRp

P/H Persistence
in >
-
of
diastolic Notch > Looks
Most
imp diameter
during
labour : Interistial diameter

Obstetric : Area blo plane of least

Outlet
pelvic dimension & anatomical

out let
.

#
Pelvis
Contracted :

Contracted inlet : OC < 10 cm

Contracted mid pelvis : Interistial dia

[8em

Contracted Outlet : Intertuberous dia

<8 em

C-section
:

* inclination
Angle of
= 550
=
 Transverse lie
Mc Congenital anamoly
also Face
-
presentation

Anencephaly
* Man chances
of
Lord prolapse I
is in
Transverse lie

Fetal Skull Diameters :

Ischial Spine
O station

Forceps & vaccum

are applied only

is station is +2

or below
Umbilical Grip
Grip
-veli
Fundal
Pawlik
-

Great Grip -

nd
T th
1st _
 Bishop's Score Pl for of
: Induction

Labour
-
-

# Cardinal Movements
Labour
:
during
①
Engagement
⑧ Descent
read
③ Flexion of
Internal Rotation
①
⑤ Extension

⑥ Resusitation
⑦ External Rotation

⑧ Lateral Fination

in verten : Head
of Baby is
by
born

Extension
#
Sages
of Loui in Breech : Head of Baby is born
by

3
① Latent phase - Ends at Sum dilatation scours in Primi Flexion
(Acg)
6 Cervin
surp in a
Mis

&
4 Third
Stage : Bein at
delivery
of labour of Baby
①Active place
->
AleBegimatbaprim.
Ends at
delivery
of Placenta .

Ends at 10 cm

③ second dilatation (3hrs Primi

3
at
stage -> Begins full + 1 hour is
Ends at Delivery of Baby [2hrg Multi epidural
given
To 2nd
preventperincal tear during stage of
labour

Best Ma >
- 2/3
MJ2 in Android Pelis
M/c level : Ischial
Spire
.

Best M/X of Breech : Elective Is at

39 week)

M/2 cause
of Preterm labour
Recurrent Breach
myc cause of
uterine Brech
-

& EC
*
Vaginal delivery is
Contraindicated in
footing
Breach .

# Manouvers for Breach

delivery :

Lovset Manoeuvre
-

Groi Traction Pinnard Manoeuvre

DorsoAut
resentation
pr

Dorso posterior Presentation

>
-
AMTSL Steps : * Uterine
Massage is
part of
PPH

is not
*
Early Lord
Clamping
a
partof AMTSL

* WHO reccomends :
Oxytocin
10 Iu
/M
3-5 mins
Oxytocin Th -
# Post-Partum
Haemorrhage
:
O
Mr
of Retained Placenta :
#
Management
Schultz (Shiny Come ot
a
M/c used method
Jetalside
:

Dull maternal side out

Duncan Method : comes
-

first

(CT- MRP
if Lord breaks during -

# Uterine Inversion MX

M/C cause :
Mismanager
grd
stage of
labour

* Immediate shock after

delivery
*
Neurogenic Shock (lb
Haemorrhagic shock

P/A exam Cup depression

:
like

P/V Enam" Bleeding

GlobularMas
is
:
+
Fetal Complications
Instrumental
D)+ BPS/Manning Score
Delivery

Pl for forcem
& Vaccur
(only </5)
① Transverse Lie

⑧ Brow Presentation

③ face-mento posterior

# Aneuploidy screening :
 white
Single
line
, Early
Proliferative
Phase
.

Triple layered
appearance of
Endometrium
in Late

Proliferative
Phase

Thick Endometrium

& posterior
Acoustic
Enhancement
on
usY
in
secretory
Phase .
 Ja
#SyndromesAssocial :

HTN
- with Diabetes &
Cancer Syndrome -
> finale
Obese
① Corpus >
- HNOCC (M2M , /MSH2)
② Lynchh II Syndrome (chromosome 10)
>
- Als PTEN
gene
③ Cowden Syndrome
-

(a) Endometrial
(a
④ BRCA1 & BRCA2 e Ovarian
mutation
.

gene

in .
Endometriosis
Laproscopic findings
Saman
Syndrome
Mullerian
Malformations
PAP-Smear Findings For Cervise Ca
Screening
. Management of In

# Cancer Cervice :
Staging for

* Dermoid Cyst

Ovarian Tumor's & Tumor Markers

-End-