"45/CO1O"4

ANATOMY & EMBRYOLOGY

:The lymphatic drainage of the cervix-1 Paracervical 15s@ /)ternal iliac 15s@ 0nternal iliac 15s@ O,turator 15s@ @&acral 15s Common iliac 15s@ Paraaortic 15s@ :The masses felt in Douglas pouch -2 -ottom of the peritoneal cavity ,etween the rectum & vagina & the . uterosacral lig' On ,oth .si#es : Masses R 3 is the commonest@ Post' wall fi,roi#@ @$y#ro-pyosalpin) (u,al pregnancy@ Ovarian masses@ Pelvic hematocele@ Pelvic a,scess@ /n#ometriotic no#ules@ Cancer rectum@ The structures et!een the 2 layers of -3 : road ligament 3allopian tu,es@ Roun# & ovarian 1igaments@ 6terine & ovarian ,loo# vessels@ 5erves & lymphatics@ Parametrium@ Remenants of 7olffian system@ Complication of female genital -" :mutilation : I e!iate &evere pain8 5eurogenic shoc9@ -lee#ing@ :amage to urethra & vagina@ 0nfection@ Psycological trauma@ : Late 6(0@ &car & 9eloi# formation@ -artholin cyst@ :ermoi# cyst & neuroma@ &e)ual pro,lems@
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REPRODUCTIVE ENDOCRINOLGY
:Causes of Anovulation-1 : Physiological Pregnancy & lactation@ Occasional in normal women@ 1st few cycles postmenarche @ & perimenopause Postmenopause@ Pathological :Ovarian@ PCO premature ovarian failure- Resistant $ ovary irili!ing ovarian tumours-"ona#al #ysgenesis $yperprolactinemia@ :%#renal #iseases@ $ypo-hyperfunction- a#ult onset C%$ $ypo-$yperthyroi#ism@ :Pituitary #isor#ers@ &immon#s #is'- &heehan $ - (umours :$ypothalamic #isor#ers@ Organic lesions-anore)ia nervosa-"nR$ #eficiency $ *allman :"eneral #iseases@ %nemia-+alnutrition-O,esity-Chronic #iseases : Causes of Hyperprolactinemia -2 : Physiological Pregnancy @ lactation @se)ual intercourse @ @-reast & vaginal e)amination .n# half of cycle@ stress @ sleep@ : Pathological :Pituitary@ Prolactinoma-/mpty sella $ - "$ secreting tumour-Cushing #isease :$ypothalamic #isor#ers@ 0#iopathic- trauma-infections-tumours 1ocal chest wall lesions: $2 @ :Others@ $ypothyroi#ism- PCO- CR3-liver failure :/ctopic@ 1ung & Renal tumours :+e#ications@ COC +%O0s-(C%-+etocloprami#e

:Causes of disordered pu erty-3 'Constitutional@ &9ull fractures@ +eningitis-/ncephalitis@ COC inta9e@ $ +cCune-%l,right@ Ovarian tumors PCO@ C%$- %#renal tumours-Cushing@ 0#iopathic@ :&redisposing conditions for '&D -" %fter menarche- premenopause@ 1st few cycles after #elivery & a,ortion@ /)cessive physical e)cersise@ /n#ometriosis@ 1ow ,o#y weight@ $yperprolactinemia $yperan#rogenism@ $ypothyroi#ism@

Chronic oil granuloma in en#ometrium or tu,e /)acer,ation of chronic P0:@ %,ortion@ oil em,olism@ (rauma@ %naphyla)is@

MEN"TRUAL DI"ORDER"
#ethods of pain control in primary -1 : $spasmodic% dysmenorrhea %nti P" : mefanemic aci#@ %ntispasmo#ics :hioscine@ COC@ $y#roco#one & co#eine@ %cupuncture@ transcutaneous electric nerve stimulation@ ;1aparoscopic uterine nerve a,lation ;165%@ Presacral neurectomy & sympathectomy@ Classification of functional hypothalamic -2 : amenorrhea : A#$o% ality i$ G$R& '(lsatility /)ercise-in#uce# amenorrhea : increase# --@ en#orphins Psychological : stress<#epression<anore)ia @ nervosa constitutional #elay of pu,erty@ :rugs: reserpine< postpill amenorrhea@

GYNECOLOGICAL DIAGNO"I"
(ndications ) prere*uisites for &ap -1 : smear : I$!icatio$s Routine screening: at 1? y an# once se)ual activity srarts 3or low ris9: every > y@ 3or high ris9 : every 1 y@ :%fter C05@ every . m for . y every > m for > y then every 1 year 0nfections : $P - can#i#a-trichomonas"'vaginalis- $& chlamy#ia '$ormonal pattern & Ovulation@ : P%e%e+(isites 5o #ouches@ 5o coitus@ 5o menses@ Contraindications ) complications of -2 : H+, : Co$t%ai$!icatio$s Pelvic mass of un9nown nature@ Possi,ility of active P0:@ 1ower genital tract infection@ Possi,ility of gynecological malignancy@ 6terine ,lee#ing or menstrual flow@ %llergy to contrast material@ Possi,ility of pregnancy@ : Co 'licatio$s Pain & neurogenic shoc9@ %scen#ing infections : salpingitis<peritonitis@

GENITAL DI"PLACEMENT
@ : Types of female genital prolapse -1 :Vagi$al )all '%ola'se :%nt' aginal wall prolapse@ Cystocele 6rethrocele Cystourethrocele :Post' vaginal wall prolapse@ /nterocele Rectocele ' ault prolapse: after total hysterectomy@ : Ute%i$e '%ola'se 1st #egree : C) ,elow ischial spine ,ut #oes not @ appear through vulva .n# #egree: C) = part of uterine ,o#y appear @ through vulva >r# #egree: uterus lies outsi#e vulva ;complete @ ;proci#entia : Co #i$e! '%ola'se 6terovaginal :#escent of uterus followe# ,y @ vagina aginouterine :#escent of vagina followe# ,y @ uterus

IN*ERTILITY
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:Treatment of female genital prolapse -2 Vagi$al '%ola'se Cystocele : %nt' Colporrhaphy = Post' @ ;colpoperineorrhaphy ;classical repair 6rethrocele: *elly suture@ Cystourethrocele: %C = *elly suture@ /nterocele: cul#oplasty or a,#ominal repair@ Rectocele: Post'colpoperineorrhaphy@ vault prolapse: &acrospinous fi)ation of cervi) @ or vagina : Ute%i$e '%ola'se :1st #egree = vaginal prolapse@ Classical repair =shortening of +ac9enro#t lig .n# or >r# #egree in young patient : @ ;&acral cervicope)y ;a,#ominal sling .n# #egree as9ing to preserve uterus : @ ;+anchester repair ;3othergill operation patients after C-P or complete# family :@ aginal hysterectomy = pelvic floor repair Ol# patients cannot tolerate maAor @ surgery : 1e-3orte operation ;partial ;colpocleisis :-tiology of genital prolapse -3 : P%e!is'osi$g -acto%s :0-Congenital +esenchymal wea9ness@ &hort vagina R 3@ &plit pelvis@ &pina ,ifi#a@ :00-%c@uire# :O,stetric;1 macrosomic fetus multiple #elivery @ rapi# succession of #elivery Poor management of 1st stage : @ -forceps-ventouse ,reech e)traction Poor management of .n# stage : @ n# -prolonge# . stage e)cessive fun#al pressure : Poor management of >r# stage@ cre#e metho#precipitate la,or & su,involution of @ uterus +enopausal atrophy : #ecrease# estrogen;. : P%eci'itati$g -acto%s 0ncrease# intraa,#ominal pressure : @ - COP: < chronic constipation 0ncrease# weight of uterus : @ - pregnancy<fi,roi# & cervical polyp 0atrogenic: enterocele after -urch colposuspension Pregnancy : PRO+ < +@ : T(#al ca(ses
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Causes of cervical factor in -1 : infertility : &ostile ce%,ical (c(s cevicitis@ %ntisperm anti,o#ies@ 0na#e@uate /strogen pro#uction@ Cervical trauma@ : A$ato ical a#$o% alities o- C. C) polyp@ C) stenosis@ C) +yomas@ +alposition of C) : R 3 < prolapse@ Previous surgery of C) :cauteri!ation < @ coni!ation < am,utation Congenital a,normalities of C) : @ atresia < congenital elongation Causes of tu al ) peritoneal -2 : factor in infertility : Pel,ic i$-ectio$s the commonest : interfers with transport of ovum < sperms & #eveloping em,ryo Pel,ic e$!o et%iosis : Bilate%al t(#al #loc/ chronic salpingitis@ uterotu,al spasm@ cornual fi,roi#s@ postoperative a#hesions@ congenital malformations of tu,es@

GENITAL TRACT IN*ECTION"

: Causes of vaginal discharge -1 : No% al sec%etio$s o% t%a$s(!ate Pu,erty < premenstrual <pregnancy@ Pelvic congestion@ puerperium :lochia al,a@ : Vagi$al ca(ses (raumatic : 3-@ 0nfections : ( = +onilia@ 5eoplasm < %#enoma < 3istula@ : Ce%,ical ca(ses 6lcers< polyps< erosions< cervicitis< @ infecte# tumors : Ute%i$e ca(ses (raumatic : 3- < 06:@ 0nfections: Puerperal sepsis@ (umors: infecte# fi,roi# < cancer @ ,o#y 3istula < Pyometra@

$y#rosalpin) < P0:@ Pel,ic a#scess : Causative organisms of acute &(D -2 ;E 5eisseria gonorrheae : ;GC@ ;E Chlamy#ia trachomatis ;HC@ +i)e# : on top of gonorrhea or chlamy#ia@ ;staph < strept < ,acteroi#s< /-coli<1esteriaB /egimens of anti iotic administration for -3 : cases of acute &(D : O%al Regi e$s :A = Oflo)acin GCCmg8# for 1G #ays@ +etroni#a!ole DCCmg twice8# for 1G #ays@ := Cefo)itin .g = pro,eneci# 1g@ :o)ycycline 1CCmg twice8# for 1G #ays@ = +etroni#a!ole DCCmg twice8# for 1G #ays@ : Pa%e$te%al Regi e$s :% = Cefotetan .g81.h 0 @ :o)ycycline 1CCmg81.h 0 @ := Clin#amycin ICCmg8?h 0 @ : "entamycin@ loa#ing #ose : .mg89g +aintainence #ose: 1'Dmg89g8?h -

: Complication of fi roid uterus-2 : 0%y cha$ges iB:egenerative: $yaline< my)omatous< cystic< fatty< atrophic changes< calcification & re# #egeneration iiB ascular: (orsion< (elangiectasis< 1ymphangiectasis< congestion & /#ema iiiB0nflammatory changes ivB+alignant changes ;C'D EB FF1eiomyosarcoma P%ess(%e: (%eth%a1 #la!!e%1 (%ete%1 %ect( & 'el,ic ,ei$s Ch%o$ic i$,e%sio$ o- (te%(s Polycythe ia &&TN I$-e%tility 0%y 'a%asitic attach e$t to a#!o i$al o%ga$ : D(%i$g '%eg$a$cy 1a#o%tio$1 al'%ese$tatio$ 2 $o$ e$gage e$t 2 : D(%i$g La#o% &'(e%'e%i( PTL1 i$e%tia1PP&1 se'sis 2

GYNECOLOGICAL ONCOLOGY
#ethods of early detection of -1 : genital malignancy CIN & ca$ce% C. : Pap smear< colposcope < C: E$!o et%ial hy'e%'lasia & ca$ce% : e$!o et%i( 68& < #iagnostic :&C < ,iopsy Ca$ce% o,a%y : ( 6&< :oppler < P <C%1.D Ca$ce% ,(l,a : -iopsy< colposcopy< tolui#ine ,lue Ca$ce% ,agi$a : Pap smear < colposcopy & -iopsy Clssification of ovarian germ cell -2 : tumors ;:ysgerminoma ;+8C@ ;/n#o#ermal sinus tumor ;/&(@ 0mmature teratomas@ 5on gestational choriocarcinoma@ /m,ryonal carcinoma@ "ona#o,lastoma@ : Diagnostic features of C(. -3 : By Pa' s ea% Replacement of normal cells ,y @ malignant cells ,ut no invasion of -+ : +alignant criteria@ %rchitectural atypia :pleomorphism : Disa!,a$tages
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GYNECOLOGICAL UROLOGY
: Types of urinary incontinence-1 : T%a$(%eth%al &60@ ;Overactive ,la##er ;O-@ ;+i)e# ;&60 =O-@ 3alse incontinence : chronic urinary retention 5octurnal enuresis : common in chil#ren@ 3unctional & transient inconteninence : - reversi,le 6- #isease : 3 E.t%a(%eth%al 3th%o(gh -ist(la (rue incontinence J':iurnal & nocturnal

@ @

BENIGN GYNECOLOGY DI"EA"E"

: Causes of endometrial polyps-1 $yperestrogenemia@ Cytological atypia : inc' nuclear si!e < inc' 58C ratio < inc' mitotic figures< multinucleoli with irregular nuclear 'mem,rane

C05 0 : low gra#e s@uamous @ ;intraepithelial neoplasm ;1&01 ;C05 00 < 000 : high gra#e ;$&01@ : By col'osco'e :;&hiller test ;staining ,y lugols io#ine@ #oes not stain ,rown : acetic aci# >E@ acetowhite : %,normal vascular pattern@ punctate< mosaic < comma-shape#< spaghetti

5ee#s provi#ers help@ +inor surgical proce#ure is re@uire# for insertion & removal 5o protection against &(0 < inclu#ing $0 @ +enstrual #isor#ers :amenorrhea< irregular ,lee#ing contraindications ) complications of -3 : (0D : Co$t%ai$!icatio$s 6ne)plaine# vaginal ,lee#ing@ aginal #ischarge@ P0: or purulent cervicitis@ &evere pain@ Pregnancy@ Past history of ectopic pregnancy@ 6terine malformations : septate< ,icornuate@ : Co 'licatio$s P0:@ Perforation@ 0ntrauterine pregnancy@ /ctopic pregnancy@ /)pulsions@ asovagal syncope@ +isse# threa#s@ :+ide effects of (0D-" :,lee#ing@ post insertion spotting intermenstrual spotting menorrhagia : aginal #ischarge@ 5on infecte# #t pelvic congestion 0nfecte# #t pelvic infection : Pain@ +il# colic #uring 1st month &evere colic #t #isparity in si!e of 06: -ac9ache #t associate# cervicitis %cute pain #t perforation The availa le methods for emergency -1 :contraception &igh !ose Est%oge$ )ithi$ 50h4 &igh !ose E 6 P4 I$se%tio$ o- c( IUD )ithi$ 50h4 Da$a7ol4 Mi-e'%isto$e3RU89:;: highly e--ecti,e4 :"(%gical4 Me$st%(al e.t%actio$ #y e$!o et%ial s(ctio$ C(%ettage

@ @

*AMILY PLANNING
: +ide effects of C2C-1 : Me$st%(al $ypomenorrhea@ aginal spotting@ -rea9through ,lee#ing@ %menorrhea +isse# perio#@ : CV" (hrom,oem,olism@ $(5@ Coronary heart #isease@ : Meta#olic 0ncrease# inci#ence of gall stones@ 1iver function impairment@ :'+@ : A$ticos otic 7eight gain@ %cne@ &9in pigmentation@ -reast engorgement & ten#erness@ : Othe%s 5ausea & vomiting@ $ea#ache@ 1eucorrhea@ Advantages ) disadvantages of -2 : su dermal implants : A!,a$tages 5o inhi,ition of lactation@ 5o special act #uring intercourse@ : 5on contraceptive health ,enefits@ #ecrease# menstrual ,loo# loss #ecrease# ris9 of en#ometrial carcinoma &afe@ /ffective : IIE@ Reversi,le < 1ong acting@

OPERATION" & PROCEDURE" IN GYNECOLOGY

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: (ndications of D)C-1 : Diag$ostic :etection of ovulation@ :etection of 1P:@ :etection of (- en#ometritis@ :etection of cancer en#ometrium or en#ocervi) :ifferentiation of :6- & organic causes of uterine ,lee#ing : The%a'(etic :6-@ /n#ometrial &C) polyps@ Postpartum & posta,ortive hge to remove the retaine# pro#ucts +em,ranous #ysmenorrhea@ &mall su,mucous fi,roi#@ removal of retaine# 06:@ : Complications of D)C-2 ; &hoc9 ;hypovolemic 8 neurogenic@ Cervical laceration@ Perforation of uterus@ 0nfection@ Complications of anesthesia@ 0ncompetent cervi)@ $ %sherman@ :Advantages of laparoscopy-3 :0n comparison to laparotomy@ 1ess inAury & ,lee#ing 1ess pain & #iscomfort 1ess woun# complications Rapi# recovery & short hospitali!ation :irect visuali!ation of pelvic & @ a,#ominal organs Collection of samples@ O,tain #irecte# ,iopsy@

@ @

&ome cases of amenorrhea ;G 3ollow up of ovarian tumor & ;D en#ometriosis /valuation of pelvic mass & suspecte# ;H uterine perforation &uspecte# P0: or ectopic pregnancy;K : The%a'e(tic :0nfertility;1 1ysis of a#hesions@ &alpingostomy &fim,rioplasty@ Cautery of en#ometriotic implants@ 1aparoscopic ovarian #rilling@ Removal of small ovarian cysts or fi,roi#s;. 0n ectopic pregnancy;> Removal of e)trauterine 06:;G (u,al sterili!ation;D Ovum pic9 up in 0 3 & "03(;H :Complications of laparoscopy-1 :(raumatic inAury@ 0ntestine6rinary ,la##er1arge vessels5erves+esosalpin):0nfections@ &alpingitis"as em,olism@ :%,#ominal wall complications@ $emorrhage7oun# infectionParaum,ilical hernia:Contrindications of laparoscopy -3 "enerali!e# peritonitis@ 0ntrauterine pregnancy@ &evere car#io-respiratory #isease@ 1arge a,#ominal or #iaphragmatic hernia@ 0ntestinal o,struction@ 0ntraperitoneal a#hesions@ Organomegaly@

(ndications of laparoscopy in -" :,ynecology : Diag$ostic :0nfertility;1 (u,al patency@ PCO@ &uspecte# en#ometriosis@ 6ne)plaine# infertility@ (/n#ometriosis (diagnosis& classification ;. Chronic pelvic pain;>

O-&(/(R0C&
NORMAL PREGNANCY
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: &arameters of fetal

iophysical profile -3

: The possi le sources of amniotic fluid-1 I$ <st t%i este%: 3iltrate of maternal plasma <0208 )/s=: 3etal urination >%! T%i este%: 3etal urination & &wallowing Othe%s: 3etal s9in< fetal "0(< fetal si#e of placenta < respiratory tract :+ure signs of pregnancy-2 :etection of fetal movements@ Palpation of fetal parts@ 3etal heart soun#@ 68&@ 6m,ilical soufflP@ Q-Ray #etection of fetal parts@ 0terine signs of pregnancy in 1st -3 : trimester : = At <0 )/s glo,ular @a,out ? cm in #iameter @the fun#us at the upper ,or#er of &'P Pal a%'s sig$ &ega%'s sig$

3etal ,reathing movements@ 3etal movements@ 3etal tone@ ;3etal reactivity ;5&(@ %mniotic flui# volume@ :(ndications of amniocentesis-4 : Diag$ostic A2Ea%ly at <:2<9 )/s=: i$ 'ts= )ith P& o% *& : oChromosomal a,normalities@ "enetic #isor#ers : L < M thalassemia@ Open neural tu,e #efect@ :iagnosis of in,orn errors of meta,olism@ :etermination of se) in se) lin9e# #s@ 3or #iagnosis of some @ hemoglo,inopathies &9eletal #efects@ : B2I$ 0$! t%i este% & ea%ly >%! t%i este% : -iliru,in estimation@ in case of Rh isoimmuni!ation for 'su,se@uent management : C2I$ >%! t%i este% : /stimation of lung maturity ,y@ 18& ratio : if F. N mature lung;Presence of P" < P0 < PC ;more relia,le%mniotic flui# creatinine1mgE NmaturityB FB -%mniotic flui# ,iliru,in ;.mgE N maturityOB ;5ile ,lue sulphate test ;fetal cells:%mniography@ use# to #iagnose "0( #efects & Rh 'isoimmun ::iagnosis of intrauterine infections@ -y culture: The%a'e(tic %-(apping in polyhy#ramnios --0n#uction of a,ortion or termination of pregnancy ,y inAection of P"3.L C-0ntrauterine transfusion in erythro,lastosis fetalis : Causes of oversi6ed uterus -5 7rong #ate@ Polyhy#ramnios@ $y#atiform mole@ +acrosomia@ Conceale# acci#ental hemorrhage@ +ultiple pregnancy@ (umors with pregnancy@ $y#rocephalus@

(mportant causes for proteinuria during -" : pregnancy Preeclampsia@ $ 5ephrotic@ "lomerulonephritis@ :ia,etes@ &1/@ /outine la oratory tests to e done at -1 : the 1st antenatal visit : Bloo! tests C-C@ -loo# group & Rh@ -loo# glucose test@ $ < &erological tests : $-&% < Ru,ella@ : U%i$e a$alysis -acteruria@ Protein@ "lucose@

/is8 factors of pregnancy that define it -7 : as high ris8 0ncresea# maternal age@ $igh parity@ -a# o,stetric history@
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OB"TETRICAL COMPLICATION" DURING PREGNANCY

+e#ical #isor#ers with pregnancy@ Psychological factors : an)iety@ 1ow maternal e#ucation@ 1ow socioeconomic status@

: clinical types of spontaneous a ortion -1 (hreatene# a,ortion@ 0nevita,le a,ortion@ 0ncomplete a,ortion@ NORMAL LABOR Complete a,ortion@ +isse# a,ortion@ (mportant diameters in the female pelvis -1 &eptic a,ortion@ Cervical a,ortion@ : related to the mechanism of la or Recurrent;ha,itualB a,ortion@ O,stetric conAugate@ O,stetric transverse@ O,stetric %P: of the outlet@ 0nterspinous #iameter@ 9hat are causes prolonging the 2nd :of la or in vertex presentation : Ca(ses i$ 'asse$ge% 1arge fetus @$y#rocephalus @+alposition Placenta previa @&hort cor#@ : Ca(ses i$ 'assages Contracte# pelvis @Pelvic mass@ : Ca(ses i$ 'o)e% 3ull ,la##er @6terine inertia@ Criteria of diagnosis of a case !ith -2 : threatened a ortion : &isto%y ostage-2 %menorrhea & other symptoms of pregnancy@ +il# vaginal ,lee#ing@ +il# a,#ominal pain or no pain@ @ : O?E "oo# general con#ition@ 6terine si!e N #ate of amenorrhea@ Close# cervi)@ : Causes of recurrent a ortion-3 : Ch%o oso al a#$o% alities (ranslocation or monsomy@ -lighte# ovum #t' triploi#y or tetraploi#y@ 3 I$-ectio$s: 3TORC& (o)oplasmosis@ Otheres : $ < chlamy#ia <mycoplasma@ Ru,ella < C+ < $& @ : Mate%$al ca(ses :3A2Local ca(ses 3(te%i$e Congenital causes as septate < ,icornuate@ $ %sherman@ Patulous internal os@ "(# (co(s -i#%oi!4 : B2Ge$e%al ca(ses Chronic nephritis @6ncontrolle# $(5@ 6ncontrolle# :+ @(hrom,ophilias@ :C2E$!oc%i$al ca(ses 1P:@ $ypothyroi#ism@ : I ($ological ca(ses $ %P1@ &1/@

-c olic drugs used to induce a ortion -3 and stimulate uterine action during la or ) to avoid atonic &&H after la or $mention : $dosage : O.ytoci$ 3or in#uction : 1C681 0 crystalloi# infusion < @ ma)' rate of infusion .C->C+68minute 3or PP$ : .C681 < rate : .CCml8h@ 3or >r# stage of la,or : D6 slowly 0 or 1C6 0+@ : E%got al/aloi!s Oral : +ethergine >-G times 8#@ 0+ : C'.mg < action starts within .-K minutes@ 0 : C'.mg slowly < starts within GC secon#s@ : 3 P%ostagla$!i$s 3PG : aginal ta,lets@ P"/1 .Dg8Gh for G #oses onlyP"/. for cervical ripening: 0ntra-uterine e)tra-amniotic@ P"3. for in#uction of a,ortion& 0ntra-uterine intra-amniotic@ intra- myometrial : -P"3. in C& or PP$ : /is8 factors for ectopic pregnancy -" (u,al hypoplasia< #iverticulae< a,sent cilia@ &urgical trauma : appen#ectomy@ ;&alpingitis ;+8C@ (- < gonorrhea@ 3i,roi#@ /n#ometriosis@
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/is8 factors of accidental -5 : hemorrhage P0$ or chronic $(5@ Chronic chorioamnionitis@ (rauma @&hort cor#@

%R(@ 6sage of POP : #ecrease tu,al motility@ /)ternal & internal migration of ovum@ /arly appearance of chorionic villi@ /arly #isappearance of !onal pelluci#a@ : &ossi le outcomes of tu al pregnancy -1 : 0nternal tu,al rupture (u,al mole@ (u,al a,ortion@ : -lee#ing may ,e@ &light: peritu,al hematoma+o#erate: pelvic hematoma&evere: intraperitoneal hemorrhage: E.te%$al t(#al %('t(%e /)traperitoneal : ;Rupture through @ ;floor ,roa# lig' $ematoma0ntra peritoneal : ;Rupture through @ ;roof Paratu,al hemorrhagepelvic hematocele&evere intraperitoneal hemorrhage.ry a,#ominal pregnancy<arities of clinical presentations of -3 : tu al pregnancy 6n#istur,e#@ &u,acute #istur,e#@ %cute #istur,e# with severe ,lee#ing@ Chronic #istur,e# with pelvic @ hematocele : Causes of antepartum hemorrhage -4 : O#stet%ic :A2Mate%$al : placental site hemorrhage@ %cci#ental hemorrhagePlacenta previa: /)traplacental hemorrhage@ Rupture# uterusCervical or vaginal tears:B2*etal asa previa@ : No$ o#stet%ic 1ocal cause as cancer C)@ : Complications of preeclampsia-11 : Mate%$al /clampsia@ Cere,ral e#ema & hemorrhage@ $ $/11P@ %cute tu,ular & cortical necrosis@ :0C@ %cci#ental hemorrhage@
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&u##en #ecompression of uterus @ @6terine anomaly @3i,roi# @&mo9ing @3olic aci# #ef' @Previous history %#vance# maternal age@ "ran#multipara @ #aternal ) fetal complications of -7 :accidental hge : Mate%$al ;&hoc9 ;hypovolemic 8 neurogenic@ :0C@ :0schemic necrosis@ Renal failure$ &heehan;Couvelaire uterus ;uterine apople)y %tonic PP$@ +aternal mortality@ : *etal 3etal #istress@ perinatal mortality@ 06"R@ Prematurity@ 5eonatal anemia@ %sphy)ia@ : Criteria of severity of preeclampsia -1; :iastolic -P 11C mmhg or higher@ &ystolic -P 1HC mmhg or higher ; Proteinuria DCCmg8#l ;=. or F ,y #ipstic9@ Or total proteinuria G'Dgm818.Gh :&ymptoms@ Persistent hea#ache-lurring of vision6pper a,#ominal painOliguria OGCCml8.Gh@ Pulmonary e#ema@ 06"R@ %cci#ental hemorrhage@ $ $/11P@ :%,normal la, fin#ings@ elevate# serum creatinine:0C : increase# 3:Ps < #ecrease# fi,rinogen-

IUGR4 *etal a$o alies4 Rh isoi ($i7atio$4 : E$,i%o$ e$tal Mate%$al age : @ <9 o% A 8B4

$epatic failure< Aaun#ice &rupture# liver @ capsule Retinal e#ema & hemorrhage@ $ypertensive heart failure@ Pulmonary e#ema & respiratory failure@ +aternal mortality@ : *etal Placental insufficiency@ 063:@ : Complications of eclampsia-12 Complications of preeclampsia@ %sphy)ia@ $yperpyre)ia@ : =ad prognostic signs of eclampsia -13 'Postpartum eclampsia@ -P F1HC811C@ (achycar#ia F1.C8m@ 3ever F >?C@ :eep prolonge# coma@ $igh num,er of fits@ %nuria or oliguria@ Raun#ice@ : DD of eclamptic fits-1" "ran#mal epilepsy@ $ysterical fits@ Cere,ral stro9e fit@ &trychnine poisoning@ $ypertensive encephalopathy fit@ (o)icity to local anesthetic@ : Causes of preterm la or-11 =I2I$!(ce! o% iat%oge$ic 3II2"'o$ta$eo(s : 35BC :A2&igh %is/ '%eg$a$cy : O#stet%ic I$-ectio$4 I$co 'ete$t ce%,i.4 Ute%i$e #lee!i$g4 M(lti'le '%eg$a$cy4 Polyhy!%a $ios4 Mate%$al ill$ess : hea%t1 &TN1 DM4 3PROM 3>BC4 :ecrease# swallowing@ :3 Mate%$al ca(ses3<DC :+@ Rh isoimmuni!ation@ Preeclampsia@ &evere generali!e# e#ema@ :3 Place$tal ca(ses3 @<C Chorioangiomas@
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Lo) height & lo) )eight4 Blac/ %ace4 Lo) soscioeco$o ic stat(s4 I '%o'e% a$te$atal ca%e4 " o/i$g4 Psychological -acto%s4 Coit(s4 3B2"'o$ta$eo(s i!io'athic 3>BC 3C2P%e,io(s histo%y 3<52>5C : Complications of &&/2#-13 : I2*etal & $eo$atal co 'licatio$ %-0nfections: .CE of cases :--Complications of prematurity R:&@ 0C$@ :C-Cor# complications Cor# prolapse@ cor# compression@ 0nfection@ ::-Complications from oligohy#ramnios $ %#hesion ,an#@ &9eletomuscular #eformity@ 1ung hypoplasia@ :II2Mate%$al co 'licatio$s :%-0nfection : &ystemic@ <septicemia< :0C< %R:&< R3 Peritonitis & septic shoc9 :0ntra-uterine@ chorioamnionitis < P' sepsis Postpartum en#ometritis --Prolonge# ,e# rest : : ( ;C-Placental a,ruption ;HE of PRO+ :-Preterm loa,or : -tiological factors of polyhydramnios -14 : 3 *etal ca(ses 3<9C $ (win to twin transfusion@ 3etal structrural anomalies@ Open neural tu,e #efect"0( o,structionOmphaloceleCar#iac anomaliesChromosomal anomalies@ (risomy 1>< 1?< .10ntrauterine infections@ (o)oplasmosis< Ru,ellaL thalassemia@ : Complications of oligohydramnios -2; %#hesions ,etween fetus & amniotic ;1 :mem,rane intra-amniotic a#hesions aroun# hea# : encephalocelearoun# lim, : amputation-

Circumvallate placenta@ 3 I!io'athic 3::C Complications associated !ith -15 : polyhydramnios : Mate%$al :uring pregnancy@ %R3%cute pyelonephritis%,normal presentations%cci#ental hemorrhagePRO+Placenta previaPressure symptoms : #ysuria< #yscha!ia PreeclampsiaPreterm la,or:uring la,or@ +alpresentation0nertiaProlonge# la,orPP$&u##en #ecrease in li@uor F &planchnic shoc9::uring puerperium@ Puerperal sepsis.ry PP$&u,involution of uterus: *etal C+3+@ Prematurity@ 063:@ $ypo)ia@ : Causes of oligohydramnios-17 063:@ 06"R@ PRO+@ Post#ate & postmaturity #t' :eterioration of placental functions Renal anomalies@ O,structive uropathy@ Renal insufficiency@ %fter amniocentesis@

aroun# nec9 : 063:s9in & amniotic mem,rane : amniotic mem,rane ,an#s 3etal #eformities ;. (orticollis(alipes e@uinovarus&9ull compressionClu, foot1im, contracture:ry #ifficult la,or & prolonge# la,or ;> +alpresentation ;G 0nfections ;D 0ntra-amniotic infection & puerperal sepsis Perinatal mortality ;H 1ung hypoplasia ;K 6m,ilical cor# compression ;? Complications of fetal hypo)ia as ;I meconium aspiration : -tiological factors of (0,/ -21 : Mate%$al Constitutional@ Poor maternal weight gain@ : :iseases@ PreeclampsiaRenal #iseaseCar#iac #isease class 000 <0 :+$ &1/ < %P1: *etal ;3etal infections ;&(ORC$@ C3+3@ (risomy< triploi#y:(eratogens@ &mo9ing%lcohol5arcotics%nticonvulsants: Place$tal placental a,ruption @ Placenta previa@ Chorioangioma@ elamentous insertion of cor#@ (rue 9nots@ &imple um,ilical artery@ : Neo$atal -lue: R:&@ 4ellow: Raun#ice@ Re#ness: Polycythemia@ $ypoglycemia@ $ypocalcaemia@ $ypomagnesaemia@
1

NON OB"TETRICAL COMPLICATION" DURING PREGNANCY

Causes of dia etogenecity in : pregnancy 0nsulin antagonism ,y $P1@ 0nsulin antagonism ,y / & P of pregnancy -1

Pro#uction of insulinase ,y placenta@ Renal glucosuria #t lowering renal threshol# 0ncrease# insulin re@uirements@

$ypo9alemia@ Car#iomyopathy@ -irth trauma@ 0nheritance o# :+@ &redisposing causes of acute -1 : pyelonephritis &ignificant asymptomatic ,acteruria@ Change of ureter in pregnancy lea#ing to : 'stasis of urine #t %tony of ureteric muscles cause# ,y P & rela)in $ypertrophy of the lower en# of ureter cause# ,y / Pressure of the uterus on ureter:Other 3actors@ :+6rinary stoneRecent catheteri!ationCardiac conditions contraindicate -3 : pregnancy ) necessitate termination $istory of (0% or arrhythmia@ &evere aortic stenosis@ $istory of heart failure@ : 1eft heart o,struction@ &evere mitral or aortic stenosisE 1eft ventricular eAection fraction O GC@ Causes of a dominal pain during -4 : pregnancy : Ge$ital :%-6terine ;Contractions ;onset of la,or-1 placental a,ruption-. Over#istention: acute poly hy#ramnios-> -reech presentation-G Rupture# uterus-D :complicate# fi,roi#-H Re# #egeneration(orsion0ncarcerate# retroverte# uterus-K %,ortion & vesicular mole-? Roun# ligament stretching-I :--(u,al Pregnancy or a,ortion-1 -tiological factors of reech -" : presentation : Ca(ses i$ the 'assages 6terine malformation as suseptate@ 3un#al myoma@ : Ca(ses i$ the 'asse$ge%s +ultiple pregnancy@ ;Prematurity ;+8C@
1

: +tigmata for potential D# -2 :I2I!e$ti-y high %is/ g%o(' :$istory of ":+@ "lucose intolerance3etal macrosomia0#iopathic polyhy#ramniosC3+3+aternal age F >D@ O,esity$(5"lucosuria F.3amily history of overt :+@ : II2&isto%y s(ggesti,e o- DM &ymptoms of :+@ &ymptoms of complications of :+@ O,stetric history of complications : shoul#er @ #ystocia :III2"c%ee$i$g tests hour postpran#ial test 1@ >hours "((@ : Causes of hyperemesis gravidarum -3 %llergy to $C"@ Psychological factors@ %#reno-cortical insufficiency@ :eficiency of vitamin -H < -1@ : >etal ) neonatal complications of ,D# -" : *etal C3+3@ C & anomalies ;+8CB : &:< %&:< ("%C5& %nomalies : %nencephaly< spina ,ifi#aOthers: 6rinary agenesis< #ou,le ureter< lim, #eformity ;$ %,sence of sacrum &11;cau#al regression063:@ +acrosomia@ ;06"R ;.CE@ /rosion< rupture-. :C-Ovaries & ,roa# ligament Complicate# ovarian cyst-1 ,lee#ing in corpus luteum-. Ovarian pregnancy-> ,roa# ligament varicosities &rupture -G varicose veins & hematoma : E.t%age$ital :%-O,stetric &evere preeclampsia-1 -ac9pain< pelvic gir#le & Aoint pain-. Rectus sheath hematoma->

@ -

:--5on o,stetric :6rinary tract-1 %cute cystitis -pyelonephritis -Renal colic :"0(-. %ppen#icitis -Cholecystitis -"astritis -

ABNORMAL LABOR
#ethods of delivery !ith deep -1 transverse arrest of head !ith fully : dilated cervix entouse #elivery@ ;C& ;safest@ ;Rotatory forceps ;*illan#@ 0f #ea# Craniotomy@ : -tiological factors of 2& position -2 Contracte# pelvis : an#roi#< anthropoi#@ 1um,ar 9yphosis@ %nterior insertion of placenta@ 3lat sacrum@ Prematurity@ Pen#ulous a,#omen@ Placenta previa@ Pelvic tumors@ Polyhy#ramnios@ +ultiple pregnancy@ ;E 0#iopathic ;1C-.C@ >actors that hinder for!ard rotation of -3 : head in occipitoposterior position 7ell fle)e# hea#@ strong uterine contraction@ %#e@uate pelvis@ "oo# pelvic floor@ 0ntact mem,ranes@

063:@ Placenta previa@ Cor# aroun# the nec9@ Polyhy#ramnios@ Oligohy#ramnios@ $y#rocephalus@ : Ca(ses i$ the 'o)e%s Pen#ulous a,#omen@ : -tiological factors of transverse lie-1 : Ca(ses i$ the 'assages Contracte# pelvis@ Pelvic tumors@ 6terine malformations@ 3un#al myoma@ : Ca(ses i$ the 'asse$ge%s ;+ultiple pregnancy ;+8C@ Prematurity@ 063:@ Placenta previa@ &hort cor#@ Polyhy#ramnios@ : Ca(ses i$ the 'o)e%s Pen#ulous a,#omen@ : Complications of t!in pregnancy -3 : Mate%$al :%-:uring pregnancy 0ncrease# maternal mortality@ : 0ncrease# ris9 to@ P0$Polyhy#ramniosPRO+%nemia%,ortion$yperemesis gravi#arum"lucose intolerance%ntepartum hemorrhagePressure symptomsPsychic #istur,ances;Preterm la,or ;DCE:--:uring la,or Preterm la,or@ +alpresentation & non engagement@ PRO+@ : Causes of o structed la or-11 : Ca(ses i$ the 'assages Contracte# pelvis@ 6terine myoma@ Ru#imentary horn@ 1ongitu#inal septum of vagina@ Rigi# perineum@
1

Cor# pro,lems@ cor# prolapsevasa previaPlacental acci#ents@ 1oc9ing twins@ 6terine inertia@ %tonic PP$@ Puerperal sepsis@ : *etal %,ortion@ 063:@

0ntrapartum #eath@ perinatal mortality@ 1ow ,o#y weight@ $ (win to twin transfusion@ C3+3@ -irth trauma@ : Causes of macrosomia-4 :+ & pre#ia,etic state@ $y#rops fetalis@ Postmaturity@ +ultiparity@ Constitutional@ : Comlications of prolonged la or-5 3etal #istress@ 0ntrauterine infections@ +aternal e)haustion@ +aternal & perinatal mor,i#ity if management is #elaye# Classification of a normal uterine -7 : action : O,e% e--icie$t (te%i$e actio$ precipitate la,or@ ;in a,sence of o,structionB Pathological retraction ring@ ;in presence of o,structionB : I$e--icie$t (te%i$e actio$ $ypotonic inertia@ $ypertonic inertia@ Constriction;contractionBring@ =3 Ce%,ical !ystocia3%igi!ity Classification of C&D ) mode of -1; : delivery +inor #egree aginal #elivery@ +o#erate #egree (rial of vaginal @ #elivery< if faile# C& &evere #egree C&@ : (rauma of@ perineumvulvaCervi)vaginaCoagulopathy@ Com,ine# factors@ : Causes of 2ry &&H-11 ;Retaine# placenta ;+8C@ 0ntrauterine infections@ 3i,roi# polyp@
1

/#ematous vulva@ Cervical rigi#ity@ (umors in :ouglas pouch@ : Ca(ses i$ the 'asse$ge%s +alpresentations & malpositions@ +acrosomia@ 1oc9e# & conAoine# twins@ : Ca(ses i$ the 'o)e%s Pen#ulous a,#omen@ : Complications of o structed la or-12 : Mate%$al %tonic PP$@ (raumatic PP$@ Rupture# uterus@ 0ntrauterine infection@ esico-vaginal fistula@ : *etal co 'licatio$s /)aggerate# caput succe#aneum@ 6m,ilical cor# prolapse@ 5eonatal ,acteremia &pneumonia@ %sphy)ia@ Over moul#ing@ 0C$@ &9ull fractures@ :eath@ : Complications of ruptured uterus -13 : Mate%$al &hoc9@ $emorrhage@ Peritonitis@ Paralytic ileus@ 0nfertility if uterus is remove#@ 0ncrease# inci#ence of rupture in later @ pregnancy : *etal +ortality is 1CCE from asphy)ia #t' Placental @ separation : Causes of 1ry &&H-1" : '%tonic PP$ #t@ Polyhy#ramnios+ultiple pregnancyConceale# acci#ental hemorrhage%nemia: Ca%!ioge$ic shoc/ $eart failure@ : Othe% ca(ses %naphylactic shoc9@ :0C@ Pulmonary em,olism@ %mniotic flui# em,olism@

6terine inversion@ 6terine su,involution@ Choriocarcinoam@ 1ocal #iseases as cervical carcinoma or polyp@ : Causes of retained placenta -13 : *ail(%e o- !esce$t 6terine inertia@ Constriction ring@ 6terine rupture@ : *ail(%e o- se'a%atio$ 6terine inertia@ : &evere a#hesions@ Placenta accretaPlacenta incretaPlacenta percreta: Causes of shoc8 in o stetrics-14 : &y'o,ole ic shoc/ :0n early pregnancy@ %,ortion/ctopic pregnancyesicular mole:%ntepartum hemorrhage@ Placenta previa%cci#ental hemorrhage:Postpartum hemorrhage@ %tonic PP$(raumatic as rupture# uterusplacenta acrreta: Ne(%oge$ic shoc/ :istur,e# ectopic pregnancy@ Conceale# acci#ental hemorrhage@ Rupture# uterus@ %cute uterine inversion@ : "e'tic shoc/ :&evere infections@ ChorioamnionitisPuerperal sepsis&eptic a,ortion-acterial to)ins@ : Ne%,e i$F(%ies -rachial ple)us palsy@ 3acial palsy@ : "/eletal & (scle i$F(%y 3racture of the clavicle@ :3racture of long ,ones@ $umerus3emur&ternomastoi# hematoma@ : "o-t tiss(e i$F(%ies :1acerations@ -y a scalpel ,la#e #uring C&-y scissors #uring episiotomy&calp a,scess@
1

NORMAL AND ABNORMAL PUERPERIUM

: Causes of puerperal pyrexia -1 ;-reast engorgement ;+8C@ Respiratory tract infections : as tonsillitis @ ;Puerperal sepsis ;most #angerous@ : (@ "eneral #iseses : as typhoi# & malaria@ >our predisposing factors for puerperal -2 : sepsis : Ge$e%al -acto%s %nemia @+alnutrition@ Chronic illness : :+ @&eptic focus@ %P$ & PP$ @Prolonge# la,or@ : Local -acto%s PRO+ @Retaine# parts@ 1acerations @0ntrauterine manipulations@ 0nstrumental #elivery@

T&E *ETU" AND T&E NEEBORN

: Causes of maternal mortality-1 $emorrhage as %P$ or PP$@ P0$@ :0nfections@ &eptic a,ortionChorioamnionitisPuerperal sepsisComplications of anesthesia@ :ifferent types of shoc9@ (hrom,oem,olic #iseases@ +e#ical #iseases aggravate# ,y pregnancy@ : >etal irth in?uries-2 : &ea! i$F(%ies Cephalhematoma@ :0ntracranial hemorrhage@ &u,#ural hemorrhage&u,arachnoi# hemorrhage'0ntraventricular or intracere,ral hge3ractures of the s9ull@ &calp e#ema -%ngulation of spine:etection of the cause0nvestigations of :0C@ Pregnancy test is ve within . wee9s@ Causes of fetal distress as causes of-1 (0,/

: I$F(%y to i$te%$al o%ga$s ;1iver ;+8C@ : Causes of (0>D-3 : Mate%$al Preeclampsia@ :+< renal #isease@ +aternal hypo)ia or C & #isease@ $ %utoimmune #iseases as &1/ or %P1@ : *etal ;Chromosomal & congenital ;.CE@ : ;3etal infections ;DE@ C+ < to)oplasmosis< malaria(wins@ Post#ate@ Rh isoimmuni!ation@ : Place$tal :Placental separation@ %cci#ental hemorrhage%,normal placenta@ (rue 9nots of the cor#@ Rupture of vasa previa@ Chorioamnionitis with RO+@ 3C U$e.'lai$e! ca(ses 3>B : #ethods of diagnosis of (0>D-" "y 'to s: "Regression of manifestations of "pregnancy Cessation of fetal movements @ Cessation of a,#ominal enlargement @ +il9 #ischarge from the ,reast @ $istory of the cause : :+ < $(5 @ : "ig$s 3un#al level O perio# of amenorrhea @ 3$& & fetal movements are not #etecte# @ 3etal parts are #ifficult to feel #t' 1oss of @ fetal tone : I$,estigatio$s :68& @ %,sent fetal movements 5o car#iac pulsation -

:Causes of elevated maternal serum G>&-3 7rong calculation of #ate@ 5eural tu,e #efects< sacrococcygeal teratoma< @ cystic hygroma Congenital renal anomalies@ 6rinary o,struction@ /sophageal & #uo#enal atresia@ $epatic anomalies@ Presence of fetal ,loo# in amniotic flui#@ +ultiple or ectopic pregnancy@

OPERATIVE OB"TETRIC"
&rere*uisits of application of the -1 :o stetrical forceps %nesthesia @&terili!ation @RO+@ /mpty ,la##er & rectum @&uita,le @ position 1ow hea# @Cervi) fully @ #ilate# Contraction of uterus @5o CP:@ &ostoperative ) long-term complications -2 : of C+ : Ea%ly %nesthesia complications@ -lee#ing anemia@ -la##er inAury@ :0nfections@ /n#ometritis6(07oun# infection: (@ : Late 0ntestinal a#hesions@ Placenta accreta@ 0ncisional hernia@ Rupture of scar in ne)t pregnancy@ : (ndications od cesarean hysterectomy -3 6ncontrolla,le PP$@ Conceale# acci#ental hemorrhage@ Placenta accrete encountere# #uring C&@ +ultiple myomas nee#ing hysterectomy@ Opera,le carcinoma of cervi)@