Obgyn

Front 1

Ferriman-Gallwey score

Back 1

tism

For hirsutism> 8 is diagnostic

> 8 is diagnostic

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Criteria for diagnosis of PCOS

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Rotterdam criteria

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Doc in hirsutism

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Ocp

With 4th gen progesterone

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Dose of misoprostol in PPH

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For prevention: 600mcg orally

For treatment: 800mcg sublingual

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Bakri balloon

1. Use

2. Capacity

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1. Pph

2. 500ml

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DOC in treatment of PPH resistant to oxytocin and ergometrine

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Carboprost

250mcg im... repeat every 15-90 min

Max. 2 mg

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Dose of carboprost in PPH

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2 mg

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Dose of Carbetocin in PPH

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100mcg iv

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Drugs used in prevention of PPH

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1. Misoprostol

2. PGF 2 alpha : carboprost

3. Oxytocin

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Drug recently recommended by WHO to be used in all pts of PPH

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Tranexamic acid

1gm iv slow infusion

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Shock immediately after delivery due to

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Uterine inversion

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Acc to ACOG , PPH is blood loss of ____ irrespective of mode of delivery.

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1000ml

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Mcc of 2° PPH

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Retained products

Front 14

Insulin resistance in pregnancy is mainly due to

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HPL

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Fetus starts producing insulin at

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12 weeks of gestation

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Gestational diabetes

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24-28 wks of gestation

Front 17

To detect congenital malformation in babies of diabetic mother

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TIFFA ie level 2 USG done at 16-20wks of gestation

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In babies of diabetic mother

1. Mc system involved in congenital malformation

2. Mc congenital anomaly seen

3. Most specific anomaly

4. Most specific CVS anomaly

5. Mc cardiac anomaly

6. Mc CVS finding

7. Least common CVS anomaly

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1. CVS > CNS

2. VSD > NTD

3. Caudal regression syndrome

4. TGA

5. VSD

6. HOCM

7. TOF

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Aim of metabolic goals in management of diabetes in pregnancy

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Fasting : 79 - 95

1hr Pp: <140

2hr Pp: <120

HbA1c: <6.5

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In diabetes in pregnancy, fetal monitoring is started

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By 32-34 wks

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Time of delivery of diabetes in pregnancy

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1. GDM, controlled on diet: >= 39 wks to 40wks+6 days

2. GDM, controlled by insulin : >= 39wks to 39wks + 6 days

3. Overt diabetes: 37wks to 37wks + 6 days

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Risk factors for macrosomia

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1. Male fetus

2. Postdated pregnancy

3. Diabetes in mother

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USG parameter to detect macrosomia

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Abdominal circumference >=35cms

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Organ least affected in macrosomia

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Brain

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Shoulder dystocia

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Delay in delivery of shoulder by >1min after delivery of head

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Turtle sign

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Sudden pulling back of head towards the perineum

Seen in shoulder dystocia

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Risk factors for shoulder dystocia

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@DOPA

1. Diabetes in mother

2. Obesity ( both maternal and fetal )

3. Post dated pregnancy

4. Anencephaly ( pseudo shoulder dystocia )

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Mc injured nerve during McRoberts maneuver

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Lateral femoral cutaneous nerve of thigh

Front 29

First and best maneuver in management of shoulder dystocia

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McRoberts maneuver

Front 30

Maneuvers done in shoulder dystocia

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1. McRoberts: flexion of legs and abduction of hips

2. Rotation of shoulder : Wood's corkscrew and Rubin maneuver

3. Remove posterior arm of baby: Jacquemier and Barnum

4. Rotate patient on all 4 limbs: Gaskin

5. Zavanelli: push head of fetus back into the uterus

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First sign of IUFD

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Robert sign of X-ray

Positive within 12-24hrs of fetal death

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Tocolytics that are contra indicated in diabetic mother

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Beta agonist ( bcz they cause hyperglycemia)

1. Ritodrine

2. Isosuxprine

3. Terbutaline

4. Salbutamol

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Tocolytic of choice in diabetic mother

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Nifedipine

Front 34

Oral hypoglycemics that can be used in diabetic mother

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1. Glyburide

2. Metformin

Front 35

Mc anomalies in infants of diabetic mother

1. CNS

2. CVS

3. MSK & Spinal

4. GUS

5. GIT

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1. Anencephaly, holoprosencephaly, encephalocele

2. TGA, VSD, Aortic coarctation, ASD

3. Caudal regression syndrome

4. Renal agenesis, ureteral duplication

5. Anal atresia

Front 36

Iron in pregnancy

1. Total amount needed

2. Iron needed by fetus

3. Lost during delivery

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1. 1000mg

2. 300 mg

3. 250 mg

Front 37

Definition

1. Anaemia in pregnancy

2. Severe anaemia in pregnancy

3. Very severe anaemia in pregnancy

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1. < 11gm%

2. < 7gm%

3. < 4gm%

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First and most sensitive marker of iron deficiency anaemia

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Serum ferritin < 30 mg/ml

Front 39

Dose of folic acid

1. To prevent megaloblastic anaemia

2. To treat megaloblastic anaemia

3. To prevent NTD

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1. 400mcg/day

2. 1mg/day

3. 400mcg / day

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Rh antigen is present on

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Short arm of chromosome 1

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Kernicterus seen when bilirubin is

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>= 20 mg/ dl

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Diagnostic criteria for hydrops fetalis

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Fluid in 2 or more body cavities.

- pleural effusion

- pericardial effusion

- ascites

- scalp edema

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Buddha sign

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Seen in USG

In cases of hydrops fetalis

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Mirror syndrome

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In Rh isoimmunization

✓ Fetus - skin and scalp edema : bloated appearance

✓ mother - pih - edema and polyhydramnios: bloated appearance

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Causes of non immune hydrops fetalis

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✓Parvo virus infection

✓congenital heart blocks

✓alpha thalassemia

✓renal: polycystic kindey disease

✓gi: volvolus

✓cystic hypgroma

✓chromosomal abnormalities

✓twin to twin transfusion syndrome

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Complete perineal tear

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3rd and 4th degree tear

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Modified Ritgen maneuver

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✓Recommended by WHO to prevent perineal tear

✓manual support to perineum with right hand and deflexion of fetal head with left hand

Front 48

Time to repair 3rd and 4th degree perineal tear

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If < 24 hrs: immediately

If > 24hrs: after 2 weeks

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Technique of repair of 1st and 2nd degree perineal teat

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1. Repair vaginal mucosa : continuous suture using vicryl/ polyglactin

2. Repair muscles: interrupted suture

3. Repair vaginal skin: mattress suture

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Technique of repair of complete perineal tear

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1. Repair rectal mucosa

2. Internal anal sphincter ( end to end anastomosis)

3. External anal sphincter ( mc end to end; best: overlapping)

4. Then repair as per 1st and 2nd degree repair

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Mc site of cervical tear

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3' o clock > 9'o clock

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Mc site of pelvic hematoma

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Vulval hematoma

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Mc artery to form vulval hematoma

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Pudendal artery

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Mc artery to form vaginal hematoma

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Uterine artery

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Indications of surgical management of pelvic hematoma

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1. Hemodynamically unstable pt

2. Increasing size > = 5cm

3. Excruciating pain

Bleeder closed by figure of 8 suture

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1. Sign of impending uterine rupture

2. Sign of rupture

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1. Fetal tachycardia

2. Fetal bradycardia

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First step in prolapse

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Retroversion of uterus

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1. Ligament that keeps uterus in anteverted position

2. Ligament that prevents retroversion of uterus

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1. Round ligament

2. Uterosacral ligament > round ligament

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Muscles that support uterus

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@BLESSD

1. Bulbospongiosus

2. Levator Ani

3. External anal sphincter

4. Sphincter urethrae

5. Superficial transverse perinei

6. Deep transverse perinei

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Muscles that don't support uterus

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Ischiocavernosus

Ischiococcygeus

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____ is not seen in congenital uterine prolapse

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Cystocele

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Management of decubitus ulcer in uterine prolapse

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Packing with acriflavine and glycerine

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_____ is used in sling surgery

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Mersilene tape