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Obstetrics & Gynecology Exam 1. Maternity and childhood protection system. Levels of maternal and perinatal care in the Republic of Belarus. Basics of legislation on maternal and child welfare in the republic of belarus ●The law on demographic security of the republic of belarus ●Decree on strengthening maternal suppor... |
●Third level of perinatal care ○Is in the regional city ○Medical care of any degree of difficulty is provided to pregnant women and their newborn children ○Regional level of perinatal care includes; ■Regional maternity hospital ■Obstetric departments of a multidisciplinary regional hospital ■Regional perinatal center ■R... |
3. Specialized obstetrics and gynecological services. Medico-genetic counseling. ●Prenatal genetic counselors work with individuals, couples, or families who have increased chances of having a child with a birth defect or genetic condition. ●Those who are already pregnant or are considering having a child in the future... |
●“Near Miss” ○A women who nearly died but survived a complication that occured during pregnancy, childbirth or within 42 days of termination of pregnancy ○3 types of near miss ■Class 1 ●Almost dead with a favorable outcome for the newborn ■Class 2 ●Nearly dead mothers and nearly dead fetus/newborn ■Class 3 ●Nearly dead... |
5. Perinatal mortality rate and ways of its reduction. ●Perinatal mortality is defined as death among fetuses weighing 1000 g or more at birth (28 weeks of gestation) who died before or during delivery or within the first 7 days of delivery. ●Perinatal mortality rate is calculated per 1000 live and dead birth x1000𝑁𝑢𝑚... |
Risk factors ●Unfavorable obstetric history ○>2 previous miscarriages or cervical incompetence ●Preeclampsia ●Gestational diabetes ●Antepartum hemorrhage ●Premature birth ●Low birth weight and birth defects ●Delivery complication ●Puerperal complication 7. Diagnostic methods in obstetrics. Prenatal screening. Diagnosti... |
8. Critical periods of fetal development. Influence of harmful factors during pregnancy. ●3 periods are distinguished in the prenatal development of the fetus. ○Ovular period or germinal period ■Lasts for the first 2 weeks following ovulation. ■In spite of the fact that the ovum is fertilized, it is still designated as o... |
9. Congenital abnormalities of the fetus. Screening for congenital malformations during pregnancy. Common congenital abnormalities ●Anencephaly ●Meningoencephalocele ●Spina bifida occulta ●Meningocele, Meningomyelocele ●Hydrocephalus ●Microcephaly ●Congenital heart diseases ●Tracheoesophageal fistula ●Esophageal atresia ... |
Screening at 15 to 21 weeks ●Detailed ultrasound assessment of fetal anatomy is commonly undertaken around 18 to 20 week's gestation ●But at this stage ultrasound is not of value in identifying Down's syndrome since nuchal translucency has disappeared at this stage (in the absence of associated abnormalities such as an... |
10. The development and functions of the placenta. Functions of the amniotic fluid. THE PLACENTA ●Human placenta is ○Discoid一 because of its shape; ○Hemochorial一 because of direct contact of the chorionwith the maternal blood ○Deciduate一 because some maternal tissue is shed atparturition. ●The placenta is attached to th... |
Functions of Placenta ●Function of the placenta is not merely the transport of nutrients and respiratory gasses. ●Respiratory Function. ○The anatomy of the fetal and maternal blood supply to the placenta ensures efficient transport of oxygen and carbon dioxide, chiefly by diffusion. ○The difference in oxygen dissociation... |
11. The structure and functions of the umbilical cord and placenta. PLACENTA ●The placenta consists of two plates. ●The chorionic plate lies internally. ●It is lined by the amniotic membrane. ●The umbilical cord is attached to this plate. ●The basal plate lies in the maternal aspect. ●Between the two plates lies the in... |
●STRUCTURES: ○The constituents of the umbilical cord when fully formed are as follows ○Covering epithelium: ■It is lined by a single layer of amniotic epithelium but shows stratification like that of fetal epidermis at term. ○Wharton's jelly: ■It consists of elongated cells in a gelatinous fluid formed by mucoid degenera... |
FUNCTIONS OF UMBILICAL CORD ●The umbilical cord plays a vital role in the transport of maternal nutrients for the development of the fetus during gestation. ●Within the fetus, the umbilical vein goes towards the transverse fissure of the liver and happens to split into two. ○One of these branches joins with the hepatic ... |
13. Diagnostics of pregnancy. SIGNS AND SYMPTOMS ●AMENORRHOEA ○An overdue menstrual period remains, for most women with a regular menstrual cycle, the first suggestion of pregnancy. ○Pregnancy is the commonest cause of amenorrhoea ○Occasionally a women may continue to bleed in early pregnancy around the time of suppress... |
○A reduction in fundal height ('lightening') may occur at the end of pregnancy when the presenting part of the fetus descends as the lower segment and cervix prepare for labour. ●AWARENESS OF FETAL MOVEMENT ('QUICKENING') ○Felt by the mother at 16-18 weeks in parous women and two to three weeks later in a primigravida.... |
●PALPABLE FETAL PARTS ○Fetal parts, such as the head and limbs, begin to be felt from around 26 weeks. ●SKIN CHANGES ○As pregnancy proceeds, areas which are already pigmented become more so — the nipples, external genitalia and anal region. ○Some fresh pigmentation appears on the face (chloasma) and on the abdomen (lin... |
14. Initial routine examination of obstetric patient: medical history, physical exam. Method for estimating due date (EDD) and gestational age. Sick leave benefits during pregnancy. GENERAL RECOMMENDATIONS AT FIRST VISIT ●PRENATAL DIAGNOSIS ○Facilities available for prenatal screening and diagnosis of fetal anomalies sh... |
●History of present illness ●History of present pregnancy ○These are hyperemesis and threatened abortion in first trimester, features of pyelitis in second trimester and anemia, preeclampsia and antepartum hemorrhage in the last trimester. ○Number of previous antenatal visits (booking status), immunization status, has t... |
○Presentation ○Attitude ○Lie ○Position ○Pelvis ○Denominator CALCULATION OF THE EXPECTED DATE OF DELIVERY (EDD): ●This is done according to Naegele's formula (1812) by adding 9 calendar months and 7 days to the first day of the last normal (28 days cycle) period. ●Alternatively, one can count back 3 calendar months from ... |
15. Anatomy of the female pelvis. Planes and diameters of the pelvis. ●The pelvic girdle, a basin shaped cavity, and consist of two innominate bone (hip bones), ○Sacrum ○Coccyx ●It is also a bony ring between the movable vertebrae of the vertebral column which it supports, the lower limbs that it rests on. ●It contains... |
●The ligaments that are important to midwifery practice are the sacrotuberous and the sacrospinous ligaments as they form the posterior wall of the pelvic outlet. Pelvis False pelvis (pelvis major) True pelvis (pelvis minor) ●True pelvis is located below the iliopectineal line, bounded anteriorly by the pubic bones, po... |
Pelvic Cavity & Outlet ●Pelvic cavity extended from the brim superior to the outlet inferiorly. ●The pelvic outlet is formed by the lower borders of each of the bones together with the sacrotuberous ligament. ○It includes the narrow pelvic strait which the fetus must pass. ●The Plane of the Outlet is bounded Anteriorly... |
16. Female pelvic floor anatomy and function. PELVIC FLOOR STRUCTURE ●The pelvic floor is a funnel-shaped structure. ●It attaches to the walls of the lesser pelvis, separating the pelvic cavity from the perineum inferiorly (region which includes the genitalia and anus). ●In order to allow for urination and defecation, th... |
FUNCTIONS ●As the floor of the pelvic cavity, these muscles have important roles to play in the correct functioning of the pelvic and abdominal viscera. ●The roles of the pelvic floor muscles are: ○Support of abdominopelvic viscera (bladder, intestines, uterus etc. ) through their tonic contraction. ○Resistance to increa... |
○Iliococcygeus ■The iliococcygeus has thin muscle fibers, which start anteriorly at the ischial spines and posterior aspect of the tendinous arch. ■They attach posteriorly to the coccyx and the anococcygeal ligament. ■This part of the levator ani is the actual “levator” of the three: its action elevates the pelvic floor ... |
●Baseline variability. ○The normal FHR fluctuates by 10 beats/min every 5 seconds or so, evidence of fetal ability to react normally to the stress of labor. ○Loss of this variability, especially in association with tachycardia, indicates severe hypoxia. (This is sometimes referred to as 'beat to-beat variation'. ) ○Acce... |
■Lag period: ●It is the time taken for the FHR to reach the nadir (the lowest point of the FHR dip) from the apex of the preceding uterine contraction. ●In deceleration lag period is > 30 seconds. ■Sinusoidal pattern: ●It resembles a sine wave. It has a stable baseline FHR with fixed or absent baseline variability lasti... |
18. Normal pregnancy events in the first, second and third trimester. FIRST TRIMESTER ●Amenorrhea ○Amenorrhea during the reproductive period in an otherwise healthy individual having previous normal periods, is likely due to pregnancy unless proved otherwise. ○However, cyclic bleeding may occur up to 12 weeks of pregnan... |
●Chloasma: ○Pigmentation over the forehead and cheek may appear at about the 24th week. ●Breast changes: ○Breasts are more enlarged with prominent veins under the skin ○Secondary areola specially demarcated in primigravidae, usually appears at about 20th week ○Montgomery's tubercles are prominent and extend to the seco... |
19. Management of physiological pregnancy. Examination and supervision of pregnant women in the woman consultation. ●First trimester ○Amenorrhea ■Cyclic bleeding may occur up to 12 weeks of pregnancy, until the decidual space is obliterated by the fusion of decidua vera with decidua capsularis. ■Such bleeding is usuall... |
○“Quickening” (feeling of life) ■Denotes the perception of active fetal movements by the women. ■It is usually felt about the 18th week, about 2 weeks earlier in multiparae. ■Its appearance is a useful guide to calculate the expected date of delivery with reasonable accuracy ○Progressive enlargement of the lower abdome... |
20. The methods of external obstetric examination. Obstetrics terminology: fetal lie, fetal position, vision of fetal position, fetal presentation. External Obstetric Examination ●Abdominal examination: inspection ○Apparent size of the abdominal distension. ○Any asymmetry. ○Fetal movements. ●Cutaneous signs of pregnanc... |
LIE: ●The lie refers to the relationship of the long axis of the fetus to the long axis of the centralized uterus or maternal spine, ●Most common lie is longitudinal (99. 5%). ●The lie may be transverse or oblique; sometimes the lie is unstable until labor sets in, when it becomes either longitudinal or transverse. PRE... |
●However, the term presentation and presenting part are often used synonymously and expressed more commonly in clinical practice according to the latter definition. ATTITUDE: ●The relation of the different parts of the fetus to one another is called the attitude of the fetus. ●The universal attitude is that of flexion. ●... |
21. Labor precursors. Physiological preliminary period: characteristics, diagnosis, management. Labour precursors FALSE PAIN: (Synonym: false labor, spurious labor): ●It is found more in primigravidae than in parous women. ●Usually appears prior to the onset of true labor pain by 1 or 2 weeks in primigravidae and by a ... |
Physiological preliminary period TRUE LABOR PAIN IS CHARACTERIZED BY: ●Painful uterine contractions at regular intervals, ●Frequency of contractions increase gradually, ●Intensity and duration of contractions increase progressively, ●Associated with “show”, ●Progressive effacement and dilatation of the cervix, ●Descent... |
22. Clinical course of labor: signs of the labor onset, stages of the labor, their characteristics. Duration of labor. ●Labor consists of a series of rhythmic, involuntary or medically induced contractions of the uterus that result in effacement (thinning and shortening) and dilation of the uterine cervix. ●The stimulu... |
○The fetus moves from the pelvic inlet down to the ischial spines, this position's called engagement. ○Then there'sflexion, where the fetal chin pressesagainst its chest as its head meets resistance from the pelvic floor. ○Next there'sinternal rotation, where the fetal shouldersinternally rotate by 45 degrees so the wide... |
ACTUAL MANAGEMENT: ●General ○Antiseptic dressing ○Encouragement, emotional support and assurance are given to keep up the morale. ○Constant supervision is ensured. ○Generally, a woman in early normal labor may not be confined to bed. ○While in bed she may take the position most comfortable to her. ○She should avoid dors... |
●Assessment of progress of labor and partograph recording. ○Pulse is recorded every 30 minutes and is marked with a dot (. ) in the partograph. ○Blood pressure is recorded at every 1 hours and is marked with arrows ( ↔ ) ○Temperature is recorded every 2 hours. ○Urine output is recorded for volume, protein or acetone. ○... |
○IV fluids, drugs. EVIDENCE OF MATERNAL DISTRESS ARE: ●Anxious look with sunken eyes ●Rising pulse rate of 100 per minute or more ●Dehydration, dry tongue ●Hot, dry vagina often with offensive discharge ●Acetone smell in breath ●Scanty high colored urine with presence of acetone. 24. Management of the second stage of la... |
○Delivery of the trunk IMMEDIATE CARE OF NEWBORN ●Soon after the delivery of the baby, it should be placed on a tray covered with clean dry linen with the head slightly downward (15°). ○It facilitates drainage of the mucus accumulated in the tracheobronchial tree by gravity. ○The tray is placed between the legs of the ... |
25. Management of the third stage of labor. ●Third stage is the most crucial stage of labor. ●Previously uneventful first and second stages can become abnormal within a minute with disastrous consequences. ●The principles underlying the management of the third stage are to ensure strict vigilance and to follow the manag... |
○Assisted expulsion: ■Controlled cord traction (modified Brandt-Andrews method) ●Palmar surface of the fingers of the left hand is placed (above the symphysis pubis) approximately at the junction of upper and lower uterine segments. ●Body of the uterus is pushed upward and backward, toward the umbilicus while by the righ... |
●A sterile pad is placed over the vulva. Ban | Ham / Aro 46 |
26. Biomechanism of the labor in case of the occipito-anterior presentation. ●The mechanism of labor is the series of passive movements of the baby, particularly its presenting part, as it descends through the birth canal. ●Illustrated is the mechanism of labor where the vertex presents in the left occipito-lateral (LO... |
Ban | Ham / Aro 48 |
Ban | Ham / Aro 49 |
Ban | Ham / Aro 50 |
27. Biomechanism of the labor in case of the occipito-posterior presentation. Ban | Ham / Aro 51 |
Ban | Ham / Aro 52 |
Ban | Ham / Aro 53 |
28. Primary sanitation and cleansing of a newborn. ●Once the head is delivered, the airway is cleared of blood and amniotic fluid using a bulb suction device. ●The oral cavity is cleared initially and then the nares are cleared. ●Suction of the nares is not performed if fetal distress or meconium-stained liquor is prese... |
29. Anatomical and physiological features of the newborn baby. Signs of a term fetus. SIGNS OF A TERM FETUS ●Healthy infant born at term (between 38 weeks and 42 weeks) ○Should have an average birth weight for the country (usually exceeds 2,500 g), ○Cries immediately following birth, ○Establishes independent rhythmic r... |
●Acrocyanosis (bluish hands and feet only) ○May be normal immediately following birth. ○It may be due to cold stress ■Plethora ●Commonly seen in infants with polycythemia. ●It may be seen in an overheated or over oxygenated infant. ●Hematocrit value may be done. ■Jaundice: ●Bilirubin level > 5 mg/d L. ■Extensive bruisi... |
■X-ray and CT scans should be taken to exclude skull fracture. ■Hematocrit and bilirubin levels should be estimated. ■Aspiration of hematoma is rarely needed as they often resolve in 4-6 weeks' time ●Craniosynostosis ○Premature closure of one or more sutures of the skull. ○On palpation, a bony ridge is felt over the su... |
○Heart ■Examined for ●Rate (normal 120-160 bpm), ●Rhythm, ●Quality of heart sounds ●Presence of any murmur. ■Murmurs may be associated with VSD, PDA, ASD, transposition of great vessels, tetralogy of Fallot, coarctation of aorta and others. ■Fetal echocardiography at 18-20 weeks gestation can make the antenatal diagnos... |
○Nervous system ■Examined for ●Any irritability, ●Abnormal muscle tone, ●Reflexes, ●Cranial and peripheral nerves. ■Neurological development is dependent on gestational age. ■The reflexes including Moro reflex are present at birth. ■Reflexes: ●Rooting reflex: ○Stroke the corner of the cheek with a finger ○Infant will turn in... |
30. Pain management in labor. Methods of analgesia. OBSTETRIC ANALGESIA AND ANESTHESIA ●During labor and vaginal delivery, analgesia can be achieved with nonpharmacologic techniques, systemic medication, inhalation agents, or regional analgesia. ●For cesarean section, regional or general anesthesia may be used. ●The ob... |
31. Programmed, induced delivery. Indication. Management. Methods of induction of labor. ●Induction of labor (IOL) means initiation of uterine contractions (after the period of viability) by any method (medical, surgical or combined) for the purpose of vaginal delivery. ●The patient and the family members are informed ... |
○Procedures: ■Preliminaries: ●It is an indoor procedure. ●The patient is asked to empty her bladder. ●The procedure may be conducted in the labor ward or in the operation theater if the risk of cord prolapse is high. ■Actual steps: ●FHR status is monitored before and after the procedure. ●The patient is in a lithotomy ... |
○It is used as a preliminary step prior to rupture of the membranes. ○It is also used to make the cervix ripe. ○Criteria to be fulfilled for membrane stripping are: ■The fetal head must be well applied to the cervix; ■The cervix should be dilated so as to allow the introduction of the examiner's finger. OXYTOCIN INDUCTIO... |
MECHANICAL: ●Dilators ○Act by release of endogenous prostaglandins from the membranes and maternal decidua to induce labor and cervical ripening. ○Hygroscopic dilators, e. g. laminaria (desiccated seaweed), lamicel (magnesium sulfate in polyvinyl alcohol) act by absorption of water. ○They swell and forcibly dilate the ... |
33. Episiotomy and perineotomy. Indications. Postpartum perineal care. ●Making an incision in the perineal body at the time of delivery. ●Surgically planned incision on the perineum and posterior vaginal wall during 2ndstage of labor. ●Objectives: ○To enlarge the vaginal introitus so as to facilitate easy and safe deli... |
●FETAL RESPIRATION ○Human fetal breathing activity is observed at 11 weeks of intrauterine life. ○Initially these are rapid and small amplitude movements (60-90 per minute). ○Fetal breathing occurs during the periods of low-voltage electrocortical activity, e. g. rapid eye movement (REM) sleep. ○During high voltage ele... |
APGAR SCORING ●This scoring is done in a newborn baby at 1 minute, 5 minutes and 15 minutes ●Long-term neurological correlation is obtained at the 5-minute score which is of more value. ●In cases where the score remains significantly depressed at 5 minutes, it should be evaluated again after 15 minutes. ●Majority of inf... |
●DEFINITIVE: ○Apgar rating—classically, the evaluation of the cardiopulmonary status in the newborn has been assessed by Apgar rating at 1 minute and 5 minutes after birth. ○Most infants born with Apgar scores of 7-10 are essentially normal. ○Apgar score 8-10 (Pink, breathing spontaneously, HR > 100 bpm). ■The orophar... |
○Baby is apneic, HR < 100 bpm despite 30 seconds of assisted ventilation (Apgar Score 0-2) ■HR > 60 bpm, to continue positive pressure ventilation. ■The heart rate is rechecked in 30 seconds of ventilation. ■Increase the oxygen concentration to 100% if resuscitation was started using an air-oxygen blend. ■Failure to in... |
35. Placental insufficiency and fetal growth restriction: symptoms, diagnosis, treatment. ●Placental insufficiency is failure of the placenta to deliver sufficient nutrients to the fetus during pregnancy, and is often a result of insufficient blood flow to the placenta. ●The term is also sometimes used to designate late dece... |
Diagnosis ●Clinical: ○Clinical palpation of the uterus for the fundal height, liquor volume and fetal mass may be used for screening. But it is less sensitive. ○Symphysis Fundal Height (SFH) measurement in centimeters closely correlates with gestational age after 24 weeks. A lag of 3 cm or more suggests growth restrict... |
●Once placental insufficiency is diagnosed management plans will usually include the following measures: ○Preeclampsia monitoring ○Referral to a high-risk fetal specialist ○Bed rest ●In addition to these management measures, doctors will usually prescribe a course of steroids. ○Steroids help to accelerate the final devel... |
36. Course and management of pregnancy in women with acquired and congenital heart defects. Indications for the abortion. ●These patients pose little problem in obstetrics. But when pregnancy occurs in uncorrected congenital lesions, problems are very much there especially in a cyanotic group. ●Major maternal risks in ... |
●Mitral Valve Prolapse (MVP): ○Is the commonest congenital valvular lesion. ○Most of them are asymptomatic. ○Women tolerate pregnancy and labor well. ○Endocarditis prophylaxis is given. Cyanotic (R to l shunt) ●Fallot's tetralogy: ○It is the most common form of cyanotic heart lesion. ○It is a combination of ■Ventricula... |
●Marfan's syndrome: ○Marfan's syndrome is an autosomal dominant condition. ○There is a 50% chance of transmission to the offspring. ○Dilatation of aorta more than 40 mm as evidenced from echocardiography is a contraindication of pregnancy. ○Beta blocking drugs should be used to maintain resting heart rate around 70 bpm... |
●Treatment ○Admission to hospital ■Indicated if the diastolic blood pressure remains at 100mm Hg or more. ■The presence of proteinuria and evidence of fetal compromise are also indications for admission. ■Many patients with hypertension arising late in pregnancy require no other treatment before delivery. ■It must alwa... |
38. The course of pregnancy and its management in women with diabetes mellitus. Indications for the abortion. Diabetic fetopathy. ●Pregnancy aggravates pre existing type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes but does not appear to exacerbate diabetic retinopathy, nephropathy, or neuropathy. ... |
○Coronary artery disease (Class H): ■These women run a high risk for ischemic heart disease especially when the disease is long standing. ○Ketoacidosis ●During labor: ○There is increased incidence of: ■Prolongation of labor due to big baby. ■Shoulder dystocia ●Shoulder dystocia is due to disproportionate growth with in... |
○A comprehensive ultrasound examination—including fetal echocardiography is done at 20-22 weeks to detect any cardiac anomaly along with other structural malformation. ■Birth injuries (brachial plexus) ●Associated with prolonged labor and shoulder dystocia due to macrosomic baby. ■Growth restriction ●Less commonly obse... |
MANAGEMENT ●Antenatal care ○Diet ○Frequent blood sugar estimation is needed ○Hb A1c level of <6% is desirable ○Ultrasound ○Assessment of fetal wellbeing made from 28 weeks onwards ○Umbilical artery velocimetry ○Insulin therapy ■When first detected during pregnancy and cannot be controlled with diet alone ■Postprandial (... |
●Care Of The Baby: ○A neonatologist should be present at the time of delivery. ○The baby should preferably be kept in an NICU and to remain vigilant for at least 48 hours, to detect and to treat effectively any complication likely to arise. ■Asphyxia is anticipated and be treated effectively ■To look for any congenital... |
40. The course of pregnancy and its management in women with thyrotoxicosis. Maternal, fetal and neonatal consequences Indications for the abortion. ●Causes of thyrotoxicosis ○Graves' disease. ○Toxic multinodular goiter. ○Toxic adenoma. ○Carcinoma. ○Subacute thyroiditis. ○Amiodarone. ○Lithium. ●Women with hyperemesis o... |
●Differential Diagnosis: ○Acute appendicitis ○Abruptio placentae ○Red degeneration of fibroid ○Acute cholecystitis ○labor ○Chorioamnionitis. ●Fetal Complications ○There may be increased fetal loss due to abortion, preterm labor, ○intrauterine fetal death caused by hyperpyrexia ○low birth weight babies (prematurity and d... |
42. Anemia during pregnancy. Features of clinical course. Treatment. Management of pregnancy, labor and postpartum period. ●Anemia is defined as reduction in circulating hemoglobin mass below the critical level. ●The normal hemoglobin (Hb) is 12-14 gm%. ●WHO has accepted up to 11 gm% as the normal hemoglobin level in pr... |
Fetal & Neonatal Risk Factors ●Prematurity ●Low birth weight ●Poor APGAR score ●Fetal distress ●Neonatal Anemia. Complications ●During Pregnancy ○Preeclampsia: may be related to malnutrition and hypoproteinemia. ○Intercurrent infection—Not only does anemia diminish resistance to infection, but also any pre-existing les... |
○Second stage: ■Asepsis is maintained. ■Prophylactic low forceps or vacuum delivery may be done to shorten the duration of the second stage. ■Intravenous methergine 0. 2 mg should be given soon following the delivery of the baby. ○Third stage: ■Significant amounts of blood loss should be replenished by fresh packed cell... |
●Effect of appendicitis on pregnancy ○May lead to ■Miscarriage, ■Preterm delivery, ■Increased perinatal mortality and maternal mortality. ○Effect of pregnancy on appendicitis is adverse because of ■Late diagnosis ■Failure of localization due to displacement of the position ■Peritonitis is more common, especially in the... |
●Symptoms and signs during pregnancy are similar to those in the nonpregnant individual. ○Major diagnostic difficulty that pregnancy imposes is differentiating between cholecystitis and appendicitis, as in the pregnant woman the appendix may also occupy the RUQ ○Pain, usually localized to the RUQ, is constant and accomp... |
LARGE BOWEL OBSTRUCTION ●Colonic obstruction is rare following gynecologic surgery but carries a high mortality rate ●The colon can be obstructed by ○Intrinsic lesions such as colon cancer or diverticulitis-related strictures or can be compressed by a pelvic mass or oreign body, such as a retained surgical sponge. ●An ... |
DIAGNOSTICS ●The clinical diagnosis of acute pancreatitis is confirmed by determination of the serum amylase level, which is above normal in 95% of cases ●The amylase level does not reflect the severity of the disease process. ●In cases where serum amylase level is normal but the clinical suspicion of pancreatitis is str... |
Mycoplasmosis ●Mycoplasma hominis and Ureaplasma spp. may colonize the human genital tract and have been associated with adverse pregnancy outcomes such as preterm labor and preterm premature rupture of membranes. ●Inflammatory reactions that arise in the genital tissues of pregnant women are a common pathway that resul... |
○A positive VDRL test ■Has to be confirmed by fluorescent treponemal antibody absorption test (FTA-ABS) and Treponema pallidum microhemagglutination (MHA-TP) test which are specific. ■Husband's blood should also be tested for VDRL ○Detection of spirochetes from the cutaneous lesion if any, ■By dark field examination ○Fetal... |
●The baby may be affected during labor while passing through the infected birth canal resulting in ophthalmia neonatorum. ●Treatment: ○Single dose injection of Ceftriaxone 125 mg IM or Cefixime 400 mg PO single dose or a single 2 gm IM dose of spectinomycin is effective. ○Both the parents are treated. ○Ophthalmia neonat... |
●There may be associated constitutional symptoms like weight loss, lymphadenopathy or protracted diarrhea. ●CD4+ count < 200 cells/mm3 is diagnostic of AIDS. ●The median time from infection to AIDS is about 10 years. Diagnosis: ●HIV diagnosis is made by detecting HIV viral RNA in blood by PCR testing (HIV RNA PCR) or b... |
●Antenatal care ○Women need screening against opportunistic infections especially when CD4+ cell count is <200 cells/mm3. ○Women on HAART should be screened for GDM. ○Screening for aneuploidy anomaly scan. ○Monitoring of plasma viral load and drug toxicities, vaccination against HBV and pneumococcal infection should be... |
○Health-care workers should be protected from contact with potentially infected body fluids. ○Estimated risk of infection after parenteral or mucous membrane exposure is 0. 36%. ○Post exposure prophylaxis with triple therapy for 4 weeks, reduces the risk of seroconversion by more than 80%. ■ZDV 200 mg tid + Lamivudine 1... |
●Treatment regimens change frequently. ●However, recommended regimens (USDHHS-2011) are: ○Two from: ■Group A plus one from either Gr. B or Gr. C. ■In resource poor settings Zidovudine 100 mg given five times daily PO can reduce perinatal transmission from 25% to 7%. ●WHO recommends first line ART regimen to include: ○Zid... |
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