Abortion expontaneo

Classified in Spanish

Written at on English with a size of 300.79 KB.

I :
Start Of Contraction
to 
Full Dialation

II:
Ful Dialation
to 
Delivery

-Null 2 Hour!
-x 1 Hour!
-Using Analegsics extend it to 1 hour more!
III:
Delivery
to 
Placenta Release



30 min
Latent : 
-Contraction More synchronized
-minimal discomfort
-Cervix effaces+ Dialation 4cm

1-Strong Irregular Contraction
2-Mucous Plug
3-Water Breaking!
4-Effacment(2cm 0-->100%)



1<20
2<14


Active:
3-4cm--->9cm

1:5-6H
2-4-5H

Decelleration:
9cm-10cm



-DO NOT STIMULATE PUSHING( Cervix Not fully dialted)


^^Med Care:
1-Vagina exmination(mecoium, effacament, Dialation....)

2-Fetal HR

3- Maternal HR + BP



Propulsive:
-Full Dialation 
until
Head Descended into pelvic Floor

-Head is relatively High in Pelvis(ocipitotransverse)
-Lower Vagina Not Stretched





Expulsive:
-From pushing sensation till delivery 
-Head is delivered in Occpitoanterior Position then return to occiptolateral!





^^Med Care:
1- Lateral raction to mother back
2- IM oxytocin to prolong contration and preent postpartum bleeding
3-Lateral Flexion( for shoulder)
4-Cut the umbilical Cord!




















^^Med care:
IM ocytocin
Cord Traction





W 11-13
W18-20
All Women:
1-CBC
2-Blood Type
3-Rh
4-Serological Markers(HIV+ Syphilius)
5-urinalysis
6-Urine Microbiology 
7- US:
-Cardiac activity
-# of Babies
-gestation Age & Size
-EDD
-changes

US:
-# of Babies
-Head position
-Top to bottum anatomy
(Cerebellum/ lateral ventricles/septum/ Lungs/ Heart)
-Cervix
-Placenta Location
-Amniotic Fluid



Chromosomal Testing For:
-Women >35
-Previous baby defect
-Teratogenic/Mutaognenic
-Her firest Line Family affected
-bnormal US/bioC
-Missed Aborton
-Father >43



W11-13(Combined)
W18-20(Triple
I-US:
CRL (45-84) = Gestational Age
Nuchal trasnlucenty (<2.5mm) , Chromosomal AbN
Nasal Echogenicity
TWins

II-hcG+ PAPP-A


I-US
-Parameters (Parietal Diameter,Abd Circumference / Femur Length)

Fetal Weight 

Fetal anomalies!





II-b-HCG+AFP+UE3
1/250--->chorionic villi sampling/amniocentisischordocentenisi

1/250-1/1000=NIPC


1/1000< Check again later



>1/250 HIGH

<1/250 
NIPS

NIPS:
-Non invasive Test checks for Fetal DNA in Maternal Blood!
Keryotype: very (S) for don Syndrome:



^^Prenatl investigation:
-Prenatal US (W11-13 &W18-20)
-Prenetal examin of chromosomal abnormalities
-RF--->T1: combined TEst( bHCg+ PAPPA) 
            T2 : tripel tst(AFP+ bhcg+ UE3)+NIPC
-Choronioc Biopsy+Amniocentesis






**Prental Care:

Low Risk
High Risk
FUH
FH
FUH
FH
FM
CTG
BPP
US
Doppler


***Postpartum Complication:
-Bleeding
-Pain
-Infection
-Endometritis
-Urinary problem
-Obstipation 
-lactostasis,mastitis


Clogged Duct/Mild endometirits---------->Oral Ax
Endometiris/mastitis/Postpartum sepsis---->IV Broad spectrum


**Prolonged 

-42W+

^^Px:
Pituitary axis
Placeta sulfacase ↓
-Mother Line
-PRevious
-aging placeta

^^Comp:
-Meconuim/oligohydramniosis(<60)
---->Cord Compression/Instrumental

-Overdue NewbornSyndrome+Macrosomia



^^Tx:
-w40: check fetal movement 2 x a day
-W41: NSt+AFI+Vagina exam
Bishop Score>6--->amnioteomy +  Labor
Bishop Score <6---->Mechanical LAbor+Misprostol




***IUGR:
<10%

SymmetricAssymetric
-Chromosomal
-Infection
-teratogenic
-Fetal dysplasia
-HBP
-Kidney problem
-DM
-Smoking
-x Gestation

^^Dx:
-Gestational age
-FUH
-Fetometry!


^^Complication:
-O2
-Death
-Csection
-Glc(-)
-RBC(++)
-Ph ↓
-seizure
-sepsis


**Induction:


IndicationInduction
- ↑ Preg
-Fetal Distress
-ROM
-Pre-Eclampsia
-IUGR
-DM
-HBP
-Chorioamniotis

-Membrane Sweeping
-Progstogland E2
-Artificial ROM
-IV oxytocin




***G-DM:

^^Px:
-Gh/Cortisol/Progesterone/HPL
---> ↑ glucose + ↓insulin (S)

^^Dx:
^^Tx:
-W 24-28
-F>5.1 /1H >10 / 2H 8.5-11.1

-Diet
-Blod glucose Moniter
-Insulin (F>5.3 + 2 H >6.7)
-NST+BPP (W34-37)
-US w34-37
-Post PArtum W 12 OGTT



MOMFetusPostbirth
HBP
C section
-Gluc(-)
-Macrosomia
-malformation
-O2
-
Glc(-)
Resp Distress
Bilirubin!


***Pre-GDM:

-Hx of complications


^^Dx:
OGTT:
F>7
2H >11.1

^^Tx:
DMI---->insuline
DMII---->Lifestlye+metformin


W11-13 Endo
W24-25
W34 Stable Glucose Deliver w 38-40
W34 unstable Glucose 


**Tx All DM pts:
1- Level III Perinatal hospitals
2- OBGYN/ ENDO/DB
3-Insulin(F<5/3+2H<6.7)
4-no GCD unless needed
5-No CSS(macorsomia, Distress retinopathy)
6-Psotpartum :opthalmost/Neonatolity


***G HBP:
^^Gx:
-HBP,W20
-Prt (-)
-12 W Postpartum disspear

^^Complication:
PA
IUGR
SGA
Preterm


^^Tx:
1-CBC/CMP/UA
2-if BP >160/110
(Labetaolol + nifepidine)
3- Fetal surveillance



***Preeclmapsia:
SxComplicationTx
HBP
Prturia
Edema
Liver enzyme  ↑
-Visual 
Headache
PA
Liver Hematoma
DIC
-Def :Delivery
-MgSO4--->Prevent seizure
-Manage HBP





I-MILD :
1-Preterm + stable---->expectant+Dexamethaome
 -Term+ Stable------>induction + Vaginal Deliver+IV MgSo4

II-Severe:
24-32---->Dexamethasone+Devliery 48 H
>32 W+Stable----> Vaginal Delivery+IVMgSO4)seizure)+Iv hydralzine+labetol(BP)

Postapartum 12-24 Mg SO4


Eclampsia:
Comp=PA-Hypoxia-CNS damage-Acidosis

StabilizeBPDefPostpartum
1-Help
2-ABC
3-O2 mask
4-MgSo4 5 g
5-Check Status
6-AntiHBP
hydralazine+IV labetalol
Delivery WHEN stable
+ Dexmthasone!
12-24 Mg So4


***HELLP:

Preecmaplsia+

^^TX:
1-Stablilize Pts
(Iv Foley athetr 16 G)
2- X:
1-AntiHBP---->Hydralazine/labetalol
2-Seizure---->MgSo4
3-Liver platlet---->dexamthasone!

3-CBC check
4-Anasthesisa
5-Delivery:
1-unstable--->direct delivery
2->34W + unstable
--->Dx
<34 W+ Stabl-->dxm


****Rh isommunization
^^Risk Group :
1-Mother Phenotype Rh(-) ,Ab titer
2-Father Phenotype Rh(+),homovs hetro
3- Fetal phenotype Amniocentsis 

^^Dx:
Screen W11-13 + W 27

^^Tx:
Rho gameRhIg 300mg W 28+ Postpartum72 H



***if Mother is Rh(-),Ab(+):
1-perinatal Care
2-OBserve Fetusfetal anemiaUS) +Amniocentsis
as the case is now High Risk

---->IC +possible blood Trnasusion if fetus is anemic!,High Risk

^^Risk: 
-Blood to Blood
1-Unscucesful pregnancies
2-Invasive Procudrues
3-ECV
4-Abdominal Trauma
5-Manual removal of placenta


***Twins:
W8
W10-13 choroicn

DC/DA=Day 3
MC/DA=Day 4-8
MC/MA=Day 8-13
Siamene>13 D


MC/DADC/DA
SameSex
-1 Placenta
-Membrane thin
-T sign + ,Lamda -
US 11-13
from W20 (4W)

--->
SameDiff Sex
Placenta 2
Membrane thick
-Lambda +
-US W11-13 ,16-18,20-22-24-28



MC/MA------->C section at W32


****Choroiamnionitis:
-infection of choroin
-polymicrobial+ROM

^^Sx:
-Fever>38 +2 (HR ↑/uterus tender/bad smell/WBC ↑ /CRP)

^^Dx:
Amniocentesis+Fluid analysis
(Glucose ↓ , WBC  ↑ ,G+Esterase(+))

^^Tx:
1-Ax (Am/Gentamicin/Metronidazl)
2-paracetamol
3-Crystalloid IV
4-Labour Induction!

PAURPP
-Uterine artery rupture


1-Painful bleeding
2- ↑ contraction
3-Distress


Dx:
CF
US

Tx:
C section Er
if Stable+term Vaginal
if Stable+preterm=bs
-Rupture of Uterus

^^Sx:
1-Popping sound
2-↓Contraction
3-painf bleeding
4-Distress


^^Dx:
US

^^Tx:
C section+Repair/hysterectomy
-Placenta in lower part of uterus
(marginal/parital complete)

^^Sx:
Painless bleeding


^^Dx:
US

^^Tx:
C section
NO TOUCH!



***PL vs PROM

PLPROM
RF:
-PROM
-x Gest
-olyhydra
-UTI
RF:
-URI
-Bleeding in T1
-Smoking
-previosu surgery

^^Dx:
-Regular cotnraction
-Irregralar contraction
-Bloody discharge
-Vagina Ph>7
-+ Crystal test
-Oligohydramniosis
-Water LEak

^^Tx:
-Rest
-CSD
-CSD+ Tocolytics!
Rest
Induce Labor
CSD(dexamthasome)
-Ax Prophylaxis
-Itnrauterine Ifnection

**PROM Monioting:
MotherFetus
-Temp
-Vaginal Discharge
-CBC+CRP
+GBS culture
-US TV
-Fetal mvoment2/day
-CTG(NST) daily
-US (ADI+BP)



***INF:


HIV:
-T1+T3
-Dx: ELISa---->western Blot
-ART therapy +No Breastfeed

VaginalC section
<50
+
ART
>50
-+Hepatitis
no ART

^^Syphilis:
Greedischarge
-70-100%
-Dx: serology RPR TPHA
-Tx:peniciclin

^^GBS:
-W 35-37
-Tx during delivery
-Tx:penicllin



^^aSx bacterua:
-W11-13
-Tx: after Urine tes NITROfurantoin 100mg



***Hepatitis B: 
-Screen T1+T3

^^Dx
serology HBsAG

--->If No ,come T3
--->If yes
1-AntiHBv/AntiHBe/HbcAg/HBeAg
2-ALT+ AST
3-CF 
4-US Ab

Tx:W28-32


***Miscarriage:
-<22W

CauseS: 
^^Examination:
1-Chrmosomal AbN
2-Infection
3-mother Disease
4-Mother Lifestyle


-Hx
-PE
-Anatomical exam
-immune 
-thyroid!




***Early Postpartum:
in 24 H (V500ml,CSS 1L)

^^RF:
-uterine ditenion
-Px Placenta
-Mother>40
-5+ Preg
-Chorioamn

^^Tx:
1-asses Blood Loss
2-Tell the pts
3- Call help
4-ABC
5-4T
6-Blood
(CBC/Rh /CF/Blood gas)
7-Def Tcx





***4T:


I-Uterine Atony
---->Massage/ Bladder Empty/
Oxytocin+misoprostol/Bimnial uterine
/Aortic compression/Lapartotomy

II-Trauma:
---->
Rapair of Cervical & Vaginal Tear/Open Vaginal Heatoma/Uterine Tear/

III-Tissue:
---->evacuation of remaining products

Thrombocyte:
---->Coagulopathy factor



***Ammenorhea:


^^Cause:
-Preg/physiolog
-PCOS
-PIt problem
-Ovary Fail
-Uterine problem
- ↑E+T

^^Dx(algo)

^^TX: according to Cause!





***ECTOPIC PREGNANCY:
N : Fertilzied Should implant into Endometrial Linning of Uterine Cavity
-Ectopic= Somewhere else
(Fallospan tube, Cervix, Abd,Pelvic cavity)


^^Complication:
Rupture of Fallopian 
(Because its too small!)

^^RF :
^^Sx:
>35
Previous 
PID 
IUD devices
x partners
Smoke
Induced Abortion

-Asx until Rupture
(Pain ,Cervical Motion tenderness +adnexal Tenderness)
+ Vaginal bleeding unlike PID
(No idea about menstrual period)


^^Dx:
-B-HCG(urine+blood)
-pelvic US

^^Tx:
-Surgery (Salpingectomy )
-X: Methyltraxate!





***C Sectrion (Scheduled & emergency)

Scheduled:
1-Previous C Section!
2-Fetal malpresentation( Breech)
3-X gestation (More then 2)

ER:
-UC prolapse
-Breech
-Peterm
-Fetal condition change( Fetal distress)
-Cephalo pelvic disproportion


***Incontinance:

^^Gx:
-inv Loss of Urine!

^^Types:

OverflowUrge(most common)
Stress
Cause:
too much urine in bladder= retention due to inactive bladder

Detrusot underactive /Obstruction
Bladder is overactive it will constantly open due to overactive muscle!

-Uncontrollable

Derusor overactive
Lack of Muscle Tone so urine leaks out during Activity!


-Action Related 

Weakness of pelvic muscle!



^^Dx:
1-CF
( volumes?)
 (  with action or without)

2-Do Pelvic Exam
(could be cystolcele , Prolapsed dropepd bladder)

3-Post void Residual Volume!
(Overflow>350)
(2+3 80-150)

4-Urinary Dairy 
^^Tx:
-Overflow---->Cholinergic Agonist!/Foley catheter
-Urge---------->Anticholinergic X( Oxybutnin)
-Stress-------->X :Pseudoephrenine  + Excercises!


StressUrge
-X: antipseudopherine
-Pelvic Excercise/Physiotherpay
-Surgery

-X- AntiCholinergic!
-Surgery




***POP & UI (Pelvic organ prolapse+ Urinary incontinance):

^^RF:
-predispostion: Anatomial problem
-Incentive
-Additional
-Decompensation

^^DX(UI):
-Complaints+ Hx!
-Test( General Exam/ Gynecological exam/pelvic muscle)

^^Tx: 
I-Conservative Measures:
Lifestlye(Weight loss)
Behvior( training)
aginal Ring
II-X
III-Sutgery

^^Dx (POP):
-Complant+Hx
-Test( Genral/Gyn /Pelvic muscle/US)

^^Tx(POP):
-Conservative measure
-Surgical Tx


***PID:

^^Gx:
-Infection of Female genital tract
-affect Cerivx uterus & xovaries!

^^Cause(STD)
-Niseiier Gonohrea 
-Chlamydia


^^Sx:
-Lower Abd Pan
-Adnexal Tender( Ovary)
-Cervial motionT..


^^Dx
-Traid: Adnexal+cervical Tendeness
-Fever
-PCR cutures( Neisena and Chlamydia)

^^Tx:
-OP Ax!----->Ceftriaxome IM/ Doxyxyxline!
-If Severe IV Ax-------->Cefoxin+ coxyclyime /Clindamycin or Gentamycin
-Tx the sexual partner!



^^Complication :
Ectopic Preg,Due to scar Tissue formed!


****Mastitis:

^^Gx :
-Inflammation of Breast
-10% of Breastfeeding mothers!
-2-3 W postprtum
-WOMEN Should NOT STOP BREASTFEED!

^^RF:
-Wrong Feeding technique
-milk duct blocked

^^Px:
Niple Crack=PAIN+ bacteria enter


^^Sx:
-Unilateral Pain
-Erythema
-Fever
-Body ache
-Malaise

^^Tx:
1-Methicillin (R) Ax
2-Anti staph X
3-Improve breastfeeding Technique!
..Encourage women to Continue breastfeding!


^^Complication :
Abscess!


***Preterm Labor:

^^Gx:
Contraction <37 W---> Cervical change!


^^Tx:
1-Ax for GBS,Pencillin/ Clindomycin/Erythrmycin
( GBS cause many Pretemr cases)
2-Tocolytic (Nifedpinedelay for 2  days)

3-CSD
(Betamethsanone=12 mg2/day )
(Dexamethosaone=6mg 4/day )


***Postpartum Fever:
-An umbrella Term Used for Conditions that Cause Fever related to the Period After Delivery

( Alt you can use one without postpartum)

-Fever >38 X+>14 D


^^Causes:
1-UTI
2-Wound Infection
3-DVT
4-X 
But the Main CAUSE is ENDOMETRITIS!


**Endometritis:

^^Gx:
-Risk Icnrease in C Section!


^^Px:
-Ascending infectio
(E epidermis/ Ecoli/ Proteus/ Klebsiella)


^^RF:
-Prolong Labor
-Prolong ROM
-Cerivcal Exam
-Materal Disease
-Delvieries using machines

^^Sx:
-Fever+Tachycardia
-Malaise
-Abdominal Pain/ Tenderness
-Leukocytocis



^^Dx:
CF  by exclusion! 

^^Tx:
IV Ax------>Clindamycin + Gentamicin!



***Fibroids:
^^Gx:
-AKA Leumyomas
-Mostly Benign tumour of SM
-Most common pelvic tumour
-Most women Have them!
-Fibrois have Estrogen (R)


^^location:
1-subserous
2-Intramural
3- submucosal



^^Sx:
1-Menohhrgia : Prlonged Duration of Mensturiation
( so if bleeding N occur 5 days now it becomes 7 )

2-Metrorrhagia:
-Mensturla bleeding  @ iregular intervals(once 28 once21 once 30 ext....)
Menometrohaggia( Cominbation of 2) =Chorionic

3-Chronic Pain /Pressure

4-Urinary Sx( Fre and Urgency)



^^Dx:
-Pelvic US

^^Tx:
1-Asx ---->observe!
2-Postmenopausal----->lack of estrogen so they regress!
3- Women who want ot get Pregnanct----->
-MYOMETCTOMY( TAKE out FIBROIDS)
-UTERINE ARTERY EMBOLIZATION
4-In Severe Sx ----------->Hysterectomy!
5- anti Estrogen X : Leuprolide GNRH anologues to decrease Estrogen Production!




***Endometriosis:

^^Gx:
-NON CANCEROUS DISORDER
-The endometrial Tissue 
(Ovaries/ Ligaments ....)
-Estrogen+ Progesterone (S)

^^RF:
-Retrograde mensturation(menstruation backward)
-Metaplasia



^^Sx:
Pelvic Pain
-Inferitlity!
-Dysmenrrohea( Pain in mensturation)
-Dyspareunia!( Pain during Sex

^^Dx:
Laporascopy!+Biopsy is a MUST



^^Tx:
-NSAID
-GNRH Agonist(Leuprolide)
(---suppress Estrogen Production)
-Excision of lesion
( uterine Artery embolization) or hysterectomy)



***Amenorhea:
1: Never had period @ age 16-7
2: didnt have Period >3 Cycles + >3 M

^^Causes:
1-Pregnancy
2-Constircitonal delay of Puberty
3-Antipsychotic(Dopamindown prolactin Down)
4-PCOS
5-Pit problem
6-Ovary Fail
7-Ovary Fail
8-Uterus structure problem
-Inrease in estoreng +testosterone

^^Sx:



***PCOS:
^^Gx:
-Elevated LH
-Insulin (R)


^^Px:
-Ovarian Growth
-Ovarian Cyst
-Androgen PRoduction!




^^Sx( endrogen Excess)
-Hirsutism
-Acne
-Kg  ↑
-irregular Menses!!
--->Can lead to Infertility!

^^Dx:
-Serum Testosterone Level
-LH( ↑+ FSH()---->Ration 3:1
-Prolactin ,TSH,
-Pelvic US ( To se enlarged follicle)
(N :2-10 mm )

2 out of 3:
1-Irregular Menses
2-Evidence of Andorgen Excess
3-Polycystic ovaries( US)

^^Tx:

I-Not desired Preg:
1-Oral Contraceptic( OCP) Suppress Andorgen metabolism---->decrease testosterone + LH levels!

2-KG 

II-Deisred Preg:
-Metformin---->insulin (S)
-Clomiphene

***Abnormal Bleeding!:
Cause:
1-Sex hormone imbalance
2- rule out structural

^^RF:
-Teens afters mencharge
-↓ KG
-Stress
-Premenopausal women 
-Obesity

^PALM
polyp
ademyosis
Liomyoma
Malignanncy & Hyperplasia
^COEIN:
Coagulopathy 
-ovulation disorder
 US Test!(+)
Visualized 

US(-)
Not Visualized!

^^Classification:
I-Est Breakthrouh
-Massive bleed-----> estorgen, with High [C]
-or slight bleeding ... Low[c]

II-Est withdrawl Bleeding:
-interruption of Exogenous Estrogen Use
-Mature follicle Destruction

III-Prog Break:
-AbN  High Ratio of Progesterone to Estrogen

IV-Prog Withdrawl Bleeding:
when effect of Exo/Endo Progesteon on endometrium is Stopped

Anovulatroy:
Ovulatory:
-Variable menstural cycle!
-unpredictable mensturation
-Frequeny spttinh


-Cycle is regular
-Dysmenoorhea
-Cyclical Breast Change
-Abd Pain in middle cycle



I-Bleeding due to Uterine pathology:
(polyp myomas)
---->Profuse!+Regular

II-Bleeding associted with sysemic Diseasee
(Thyroid diseases, Hyperprolactinemia,)

---->Profuse Regular or Irregular
(Menorrhagia/Menometrohaggia)

III=Dysfunctional uterine bleeding
(Hypothalmis(-)/PCOS)
---->Profuse Irregular Bleeding
(Menometrorrhagia)


Latrogenic Bleeding
(Irrational Hormonetherapy/anC)
--->irregular bleeding of menotroggia

^^Tx

X:
Hormone COC
NSAID
Tranexami acid
IUD
Levonogesterol
Surgery:

Endometria resection
Endometrial ablation!
Hysterctomy!

***Infertility :
-Inability to Convience in 1 Year!
-Both Partner need to be Tested!

^^Causes:
1-Ovulation problem(PCOS)
2-Fallopian Tube problem
(STI /Infe/Endometiosis)
3-Sperm 
(Qulity/delivery problem)


^^Dx:
1-General & reporductive Hx
2-Clinical Evaluation
3-Gynco Exmaination
(speculum,vaginal smear, PAP smear)
4-US  internal Genitalia
5-Sperm Assesment:
Volume>2
Liquefication <60min
Ph :7.8-8
[C]>15 mln/ml
ejaculate >40 mlm
Motility>32%
Kryger>4%
Vitality >75%

6-Ovulation assement:
US
Indirect Test( Midluteal phase)

7-Ovary function:
Hormone Profile (FSh/LH/SHBG)

8-Tube assesment:
Laparoscopy+DYE!

^^Tx:
OvulationTubeSperm
-Clomiphene citrate

-NS (-) of Aromatase!

-H-Gonatrophins : FSH+hCG, FSH+LH+hCG!

-Surgical Ovulation inductio-Laparopscopic ovarian drilling

1-sugery
( Microsurgical tuboplastry + reanostomosis)
(removal or periadnexial adhesion ,Laparoscopic)

2-Tube Catherization For Proximal Tube occlusion
1-endocrine problem
(Human Gonatrophins)


2-Imune problem
ART




***ART:

IUIIVDICSI
↓ Cervical Mucous

-Endometriosis

-Unexplained Infertility

-Low [Sperm]
-Sperm Ab
-Irriparable Fallopian Tube
-?
-Severe endometriosis
-Male inf







***Contraceptive!:

**Copper IUD:
-Long-acting+ reversible 
-Very effective (Pearl index <1)
-may be placed
for 10, 5 or 3 years
-may be used for
emergency contraception

Levonorgesterol-Releasing IUD:
-May be used for Heavy Bleeding mensturation

CI:
-Preg
-Infec
-Vaginal bleeding 
-Untreated endometrial or cervical
cancer
-Breast cancer (only LNG-IUD)
-Gestational trophoblastic disease
-Tuberculosis of pelvic organs


**COC:
Types :Pil/ Vaginal Ring/Transdermal

+:
-estrogen and a progesterone
-Ensures effective contraception
-Pearl index 9
-non contraceptive) effects:
1-Diminishes acne
2-Ensures the regulation of menstrual
cycle
3-Lowers the probability of ovarian,
endometrial and colorectal cancer
4-Lowers the manifestation of bening
breast formations
5-Less ischmia

-:
1-thromboelic Com
2-Mood swing
3-cervical Cancer




CI:
<6W after birth
-Breastfeeding
->35 YO+ smoking
-HBP II
-Vascular problem
-DM
-Hepatitis/Cirhoosis
-Stroke
-Heart Problem
-Breast Cancer!

**Progestine only CI:
Pilll=index 9
Injection=6
Implant <1

I:
Breastfeeding women
when E is CI
Pill Taken Daily
implant for 4 Yeas
-Injection  12-28 W

CI:
-Breast Cancer
-DVT
-Liver problem
-SLE
-migraine!



**Menopause:


^^Gx:
-Stop of menses  for12 M post last
-Av age:around 50
-↓ Estorgen.↑ FSH


^^Sx(HAVOC):

1-Hot Flashes

2-Atrophic Vginitis
(dryness)

3-Osteoporosis
(resorbed by osteoclast)

4-Coronary artery Diseas

^^Dx:
-Clinical
-you may check FSH, LH,Estrogen
^^SX( toward managing Sx):
1-Hot flashes----->SSRI(Fluoexteme)
2-Atrophic Vagina--->Give Estrogen Creams
3-Osteoprosis---->Bisphosphnates



HRT indicated for Vasomotor Sx, Insomnia,Sweating!

+
E+P 
E only if she had Hystectomy
-:Giving estorgen makes Women Feel better
-Breast Cancer
-Stroke
-DVT
-Pul Edema



***Cervical Dysplasia:


 I-CINI( CIN1)-=Abnormal cells 1/3 of epithelium
(Low Grade Squamous Intrapethilal lesion LSIL)

II-CIN2 (Moderate): 
-Abnormal Cell= >2/3 Of epithelium
-HSIL : High Grade Squamous intraepthlial Lesion

III-CIN3:(Carcinoma in situ)
-Abnormal cell> 2/3 of epithelium
-High Grade Squamous intraepithlial Lesion

IV-Abnormal cell Found Depper then Basal Layer:
Invasive CANCER!


^^Dx:
-PAP smear (SCRREN can catch precancer stages)
-Liquid cytology
-Immuncytochemical stain
-Colposcopy:

IF PAP smear Abnormal----->Do Colposcopy!+Biopsy!

^^Tx:
CIN1-------->Local Destruction/xcision
CIN3-------> Hysterctomy  if another Px is seen / excision


**Cervical Cancer:


^^Gx:
-SCC

^^Cause :
HPV invading the BM(16.18.30's=12 types)
HPV is an STD!
Smoking

^^Types:
I=In cervix
II=outside Cervix but not beyong pelvic floor and lower 1/3of vagna
III=pelvic floor +lower 1/3 Vagina
IV=Bldder/rectum /distant mts
^^SX:
Asx until Cancer Spreads



^^DX:
SCREEN: PAP SMEAR!
------>If Abnormal
DO COLPOSCOPY +BIOPSY!

if Cancer Confirmed , Staging is Needed by CT/ MRI

^^Tx:
-Localized Excision
-If Spread : Radiotion + chemotherapy!
-PREVENTION IS KEY (Screen+ HPV vaccine)


I st in Cervix only
IA1(Microinvasive) 
Conization of cervix/Hysterctomy
II st
Disease beyond cervic  but not below 13 of vagina+pelvic wall
IA2+IIA2:

Radical hysterctomy
+LNtomy

Radio/Chemo
IIIstIn pelvic wall /lower1/3 Vagina
IIIB-IVA:
Combined Chemo
IVinvades bladder , rectum or distant metases!
IVB:
chemo,Biological


***Endometrial Hyperplasia:
^^Gx:
-Without Atypia
-Atpica hyperplasia( Precancerous)

^^Sx:
Postmenopausal bleeding (Prolonged)
-irregular bleeding while HRT 
-No Sx



^^Dx:
-Hx + CF
-Transvaginal US 
-Endometiral Sampling Biopsy(pipelle)
-Uterine curettage
-Hystercocpy & Biopsy!

^^Tx ( without Atypia):
-resolves without Tx
-x: Gestagen 
-Hysterectomy if Sx persist!






***Endometrial Cancer:
(Most common Genital Cancer in Women )
-Mostly POSTMENOPAUSAL women!
-Caused by too much estrogen(unopposed)
-RF: Obesity/PCOS/late menopause/Nulliparity

^^Sx:
-POSTMENOPAUSAL Vaginal Bleeding (BAD)!

^^Dx:
I-Gyn Exam+Hx
II-TV US
III---->Endometrial biopsy!
IV-Abdomina US/CT +Xray For Staging!
^^Tx:
I-Surgery
( TH + bilateralSalpindoooprectomy )
II-Radiotherapy
III-Chemo
IV-Hormonal!(progesterone)




***Ovary Cyst:

^^Types:
I-follicular: when follicle fails to ovulate+ perissit
II-corpus lutem:when Serousfluid/ blodo enter Corpus luteum



^^Sx:
-Asx
-Lower Abd Pain
-Mensturial cycle disorder


^^Comp
-Lower Abd Pain
-Mensturial cycle disorder
-Hemmohargic shock =due to rupture of cyst and bleeding
-Torsion






^^Dx:
US scan
(Chamber tumour/ Size/ trasnpercy)

^^Tx:
1-dissapear in2-3 M
2-X: COC/ Progestin
3-Surgery : Cystectomy/ Adnextomy!
(indication when Sx icnrease/ )


***Ovary Non malignant:

^^Type:
I-serous mucinous Cystadenoma
II-Mature Teratoma

^^Sx:
-Asx
-May Cause Lower Abd Pain 
-Pelvic Pressure
-chenge in Bowel



^^DX:
-Gyn exam: Palpation of Tumour
-US
-Lab Ca125 Markers

^^Tx:
-Asx Moniter
-Surgery (Cystectomy)






***Malignant Ovrian Tumour:

^^Gx:
-90%  epithial cancer
-Highest Mortliaty of all Gyn Cancer


^^Sx:
-Asx(initially)
-accidental finding
-Abd pain/ increased pass/
-Weight loss
-Chenge in Bowel
-Pelvic pressre




^^DX:
I-Hx
-Sx
-Gyn Exam
-Lab Test Ca125/CEA/CA19-9 
-Pelvic US
-CT
-Endocopy
-Xray

^^Tx:
-Hysterecony+adnextomy
-Lperitoneal biopsy
LN biopsy
Cytroeducitve surgery( reduce Size)



^^AntiD Immunoglobulin Prophylaxis of RH (- Women durgin pregnancy and postpartum period!

-Checking the Fetus Blood,by Amniocentesis)+ Free Fetal DNA in Mother=NIPT

-Susceptible: Mom RH(-) / Father Rh(+) / Genotype Amniocentesis!

If MOM is RH (-) we Give Rhogam at 28 W + 72 H of Delivery / Procedure!
Rhogam is an Ab agaisnt Rh + antigen! But it has a Receptor that mom Cant Recognize!, It Help Hides the antigen from mother preventing her from developing an Immune Response against it

Rhogm: Anti-RhD Ab!


RF : Hemolytic Anema of Fetus!



^^Terminology , Risk Factos and Dx of Cervical Dysplasiaplasia!


Cervical dysplasia=Abnormal Tissue Growth ,Pecancerous Condition! Which may progress to Cancer!

-The Biggest RF are:
1-HPV which is Transmiited Sexually(strain 26,18, 39=0;s -12 strains)
2-Early onet of sex
3-no protection
4-no smoking


 I-CINI( CIN1)--------->Abnormal cells 1/3 of epithelium
(Low Grade Squamous Intrapethilal lesion LSIL)

II-CIN2 (Moderate): 
-Abnormal Cell >2/3 Of epithelium
-HSIL : High Grade Squamous intraepthlial Lesion

III-CIN3:(Carcinoma in situ)
-Abnormal cell> 2/3 of epithelium
-High Grade Squamous intraepithlial Lesion

IV-Abnormal cell Found Depper then Basal Layer:
Invasive CANCER!


^^Px:
-HPV enters the BM replicates in maturaing Squmous cells-----> Koilcytic Atypia!

^^DX:
I-SCREEN: PAP SMEAR!
------>If Abnormal
DO COLPOSCOPY +BIOPSY!

if Cancer Confirmed , Staging is Needed by CT/ MRI

^^Tx:
-earliest Stage of PRecancernous tissue , Can be Removed!
1-Cryotherapy
2-LEEP
3-Laser



***G-DM:
-DM that develops Durgin Preg!
-lead to Macrosomia+malformation!\\


^^RF:
^Dx
-Obesity +previous cases!
->35YO
-Polyhydrom
-Famly Hx of DM

-W24-28 Screen
-75g OGTT:
F >5.3
1H> 10
2H >6.7
(11.1 < Overt DM



^^Tx:
1-offer DIET
2-Check Blood glucose4-6 x /3 days
3- Still Abnomrla---> Diet+ Insulin
(if diet worked stay on it)

(Desired F<5.3/<6.7 /HbA1c<6/5%)


^^Complication:

MateralFetal
-C sectionrisk
-Infection
-Post-P bleed
-nephropathy
-Glc+
-PHBP
-Congenital 
-Macrommia(>4500)
-Hypoglycemia
-RBC(++)
-Bilirun(++)


***Preclapsia:


^^Dx+Tx:


I-MILD (no Sx):
1-Preterm+ stable: Expanctant + Betamethasome
2-Term/unstable: induction of lavor+ IV Mg Sulfate !

II-Severe:
I-24-32W+ Stable:
Expectact + betamethasone!

2->32 or unstable:
Induction + IV MG sulfate(Seizure)
+ IV labetatlol( BP)

III-GIVE mg Sulf 12-24 H postpartum!!
MG given 5 g!



***Eclampsia Tx:
1-Stailize:
-ABC
-O2 mask
-Seizure control---> 5g Mg sulfate


2-BP control
-Labetaol/IV hydralazine 

3-Def Tx:
Betamethasone if <34W
prepare ofr Delivery when STABLE!




***HELP***
^^SX:
^^Dx:
RUQ Pain
HBP
N+V
Ecmallmpia
Visual change!
-suiezure
-CBC
-BP measurement
-Lvier enzyme
-PT + PTT



^^Tx:
I-stabilize
-IV access
-Foley 

II-Anti HBP
Labetaol/ Ic hydralazein


3-Siezure X
---> Mg Sulgfate

IV-check CBC

V-Notify anasthesia

VI-Delivery:
-unstable------>direct delivery
->34 W+ unstable------>DXM +24/48 hours delivery
-<34W+ stable----------->DXM + eveluate delvier 24-48 H


***C-amnitis:

^^Gx: 
-ROM
-Maternal Fever

^^Cause:
polymicrobial+ ascneding!


^^RF:
prolong ROM
-DVE
-Epidural anasthesia

^^Comp:
C section  ↑
Endomertris
Absess
Bacteria
Cerebral palsy
neonate Spesis!
^^Sx:
-Materal T(>38)
-Mom HR  ↑
-Fetal HR  ↑
-Uterine tende
-WBC ↑





^^Dx:
-Gold=Fluid analysis Via Amniocentesis
(Glucose -/ WBC  ↑/PRt  ↑/Gram(+)/Esterase(+))

^^Tx:
1- IV Ax : Ampicillin & Gentamicn
(Clindamycin if youll do C section)

2-Antipyretic :Acetominophen !


***IUGR:
-<10%


^^Cause:
SymmAymmetirc
Chromosomal AbN
Fetal Dysplasia
Chronigh HBP
Kidney prob
-DM
-x Gest

^^Complication:
-Fetal O2(-)
-Fetal Death 
-C section ↑

Glc(-)
RBC++
Acidocis
Na(-)
Seizures


^^Dx:
-G age
-Fundal JHeight
-Fetomertry (32W)
(fluid+umbilical artery Dopp)

***Post-Preg com:
-Meconuim
-Oligohydramniois
-Newborn Syn
-Macrosomia( >90%)

***Induction
Ind:
-Long preg
-Fetal Disress
-ROM
-HBP
-Rh factor
-DM
-HBP
-Placental Abruption

Methods:
-sweeping membrane
-Artificial ROM
-PG E2
-IV oxytocin!


***PL vs PROM

PLPROM
RF:
-PROM
-x Gest
-olyhydra
-UTI
RF:
-URI
-Bleeding in T1
-Smoking
-previosu surgery

^^Dx:
-Regular cotnraction
-Irregralar contraction
-Bloody discharge
-Vagina Ph>7
-+ Crystal test
-Oligohydramniosis
-Water LEak

^^Tx:
-Rest
-CSD
-CSD+ Tocolytics!
Rest
Induce Labor
CSD(dexamthasome)
-Ax Prophylaxis
-Itnrauterine Ifnection

**PROM Monioting:
MotherFetus
-Temp
-Vaginal Discharge
-CBC+CRP
+GBS culture
-US TV
-Fetal mvoment2/day
-CTG(NST) daily
-US (ADI+BP)

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