DD of abdominal pain during pregnancy
@obstetricsgynecology1

⭐️Causes of Increased Maternal Serum Alpha Feto Protein during pregnancy:

.Intestinal obstruction
.Multiple gestation/ Miscalculation of gestational age(common cause )/ Myeloschisis
.Spina bifida cystica
.Anencephaly/ Abdominal wall defect
.Fetal death
.Placental abruption
@obstetricsgynecology1

Dx of infertility
@obstetricsgynecology1

🗓POSTOPERATIVE COUNSELING POINTS AFTER ECTOPIC PREGNANCY:

🔖 Explanation of diagnosis and operation.

🔖Appropriate counselling that the woman may grieve (this is the loss of a pregnancy) with advice about further support.

🔖Avoid the progesterone only contraceptive pill (POP) and intrauterine contraceptive device (IUCD) (both are associated with a slightly higher risk of ectopic pregnancy).

🔖 Approximately 65–70 per cent of women who have had an ectopic pregnancy go on to have a live birth following this,
🚨 but there is a 10–15 per cent chance of a further ectopic pregnancy

🔖Early transvaginal scan is indicated at around 5 weeks’ gestation to confirm the location of any future pregnancy.

🔖 Effective contraception should be used if she does not wish to become pregnant again at the moment.

#Good_Luck
@obstetricsgynecology1

🗓DIAGNOSIS OF ECTOPIC PREGNANY

🗓Diagnosis of ectopic needs high level of suspicion ,you should be "ectopically minded" in any pregnant case especially the high risk group (PID ,IUCD ,POP)

🗓Pregnancy test :detect the serum B- HCG which is normally doubles in intrautrine pregnancy -3 days
-subnormal rise ,less than 66%within 2 days may indecate ectopic
(B-HCG less relative indecate of ectopic becouse may be non -viable intrautrine pregnancy )

🗓If there is a doubt that this situation is "ectopic pregnancy" should be hospitalized &follow up by
1⃣Serially combined U/S + B- HCG
The discrimination value at wich U/S can detect an intrautrine pregnancy
6000mIU/ml (by abdominal U/S ) or
2000mIU/ml (by vaginal probe )
"Any level above this +no intrautrine preg .detected by U/S ➡️ will be most ectopic

2⃣ Serial hb & hct to detect any internal hge is suggested by progressive drop in Hct in absence of external bleeding

📌📌 If diagnosis of intraperitoneal hge is evident➡️ (Proceed directly to laparotomy)

🗓If diagnosis is still query ➡️
*laparoscopy ➡️ (both diagnostic &therapeutic)

3⃣Others :
*progesteron level less than 5ng/ml ( ectopic or non -viable intrautrine pregnancy )

D&C ➡️ to detect decidual villi but❌❌ (it may disturb an early healthy pregnancy !!)
@obstetricsgynecology1

✳️ Short notes ( chlamydial infection ) :

🔅Chlamydia Trachomatis is a Gram –‘ve obligate intracellular bacterium.

🔅Clinical Presentation in Males
o Urethritis, epididymitis, prostatitis, proctitis

🔅Clinical Presentation in Females
o Urethritis, cervicitis, salpingitis, perihepatitis

🔅Diagnosis
o Endocervical and urethral swabs

🔅Treatment
o Doxycycline or Azithromycin


#Good_Luck
@obstetricsgynecology1

✳ short notes( Neisseria Gonorrhoeae infection )

🔅 a Gram –‘ve intracellular diplococcus.

🔅Clinical Presentation in Males :
o Urethritis, epididymitis, prostatitis, proctitis, pharyngitis

🔅Clinical Presentation in Females :
o Asymptomatic, endocervicitis, urethritis, PID

🔅Disseminated Gonococcal infection :
o Bacteraemia, skin and joint lesions

🔅Diagnosis :
o Smear and culture

🔅Treatment :
o Ceftriaxone (Intramuscular Injection)



#Good_Luck
@obstetricsgynecology1

🗯📌 DIFFERENTIAL:

👁‍🗨 The differential for a woman of childbearing age with abdominal/pelvic pain
or abnormal vaginal bleeding includes:

■ Ectopic pregnancy
■ Mittelschmerz
■ Appendicitis/cholecystitis
■ Intrauterine pregnancy
■ Ovarian cyst/torsion
■ Threatened abortion
■ PID
■ Inevitable abortion
■ Endometriosis
■ Molar pregnancy
■ UTI/renal colic
■ Heterotopic pregnancy
■ Inflammatory bowel disease (IBD).
■ Corpus luteum cyst.



#Good_Luck
@obstetricsgynecology1

🗯♦️Common side effect of HRT :

🅾️estrogen related :

🔴Fluid retention
🔴Headache
🔴Breast enlargement
🔴Leg cramps
🔴Dyspepsia


🅿️rogestogen related :

🔵Fluid retention
🔵Breast tenderness
🔵Headache
🔵Acne
🔵Mood swings
🔵Depression
🔵Irritability
🔵Bloating
🔵Constipation
🔵Increase appetite


————
Resource : 10 - Teachers

#Good_Luck
@obstetricsgynecology1

🤒🌡📎 Puerperial Pyrexia

🔆A clinical sign that merits careful investigation.
🔆 A temperature of 38 oC on any 2 occasion in the first 10 days after
delivery excluding the first 24 hr.

🔅🔅CAUSES :

1. Urinary tract infection

2. Genital tract infection

3. Breast infection (mastitis, abscess)

4. Deep vein thrombosis or pulmonary embolism

5. Respiratory infection

6. Other non-obstetrics causes

7. Surgical wounds e.g. C.S.



#Good_Luck
@obstetricsgynecology1

🔎 Implantation Defects ‼️


🔘Ectopic Pregnancy :

⚪️Implantation at site other than uterine body
⚪️Most commonly fallopian tube
⚪️Can be peritoneal or ovarian
⚪️Can very quickly become a life- threatening emergency


🔘Placenta Previa :

🔴Implantation in the lower uterine segment
🔴Can cause haemorrhage in pregnancy
🔴Requires C-Section delivery


🔘Incomplete Invasion :

⚫️Placental insufficiency
⚫️Pre-Eclampsia

——————-
#GOOD_LUCK
@obstetricsgynecology1

Antenatal steroids
1. Dose
The National Institutes of Health (NIH) Consensus Panel and the ACOG recommends

A) dexamethansone 4 mg IM × every 12 hours, for 4 doses for all women in preterm labor between 24 and 34 weeks’ gestation.

B ) betamethansone 12 mg IM × 2 doses, 24 hours apart if more than 2 weeks had passed and the gestational age was less than 33 weeks.

# Corticosteroids are not recommended for use in pregnant women who are at more than 34 weeks’ gestation unless there is an indication of fetal lung immaturity.

2. Role
facilitate fetal lung maturation by increasing production of fetal lung surfactant, thereby reducing the incidence and severity of RDS,Antenatal corticosteroid also decreases the incidence of intraventricular hemorrhage, necrotizing enterocolitis, and neonatal death

3. Important notes
A) The greatest reduction in RDS occurs when delivery can be delayed 24 hours up to 7 days after starting treatment.

B ) Betamethasone, however, might be the preferred agent because fewer IM injections are needed and because in meta analysis it was associated with a greater reduction in RDS compared with dexamethasone.
also in the reduction of periventricular leukomalacia, a finding associated with later risks for cerebral palsy.

4. Warning
Repeated weekly corticosteroid courses should not be given because of the association with decreased birth weight and head circumference, hypothalamic- pituitary-adrenal axis suppression, deleterious effects on cerebral myelination and lung growth, and neonatal death .

#Ben_Ali
@obstetricsgynecology1

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انضموا اليها 👇👇


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Enzyme inducers and contraceptive pill


A disrespectful but good #mnemonic to remember for enzyme inducers is:

CRAP GPs 🙈💩

✍ Whilst majority of GPs are absolutely fantastic, if a GP prescribes rifampicin and combined oral contraceptive pill without informing the woman of contraception failure, he may be called a Crap GP. A good GP would discuss the use of additional barrier methods, having progesterone only injections, insertion of intrauterine devices or use of increasing dose of oestrogen.

⛔ Carbamazepine
⛔ Rifampicin
⛔ Alcohol – chronic consumption
⛔ Phenytoin

⛔ Griseofulvin
⛔ Phenobarbital
⛔ sulfonylureas


#obs_and_gyneacology
〰〰〰〰〰〰〰〰〰〰〰

للمزيد اشتركوا بالقناة من هنا 👇
@mnemonicmedical

🔶Casues of secondary amenorrhea:

🔹Pregnancy
🔹Breastfeeding
🔹Stopping the use of birth control
🔹Menopause
🔹Some birth control methods, such as Depo-Provera or certain types of intrauterine devices (IUDs)
🔹Stress
🔹Poor nutrition
🔹Depression
🔹Certain prescription drugs
🔹Extreme weight loss
🔹Over-exercising
🔹Ongoing illness
🔹Sudden weight gain or being very overweight (obesity)
🔹Hormonal imbalance due to polycystic ovarian syndrome (PCOS)
🔹Thyroid gland disorders
🔹Tumors on the ovaries or brain (rare)
🔹pituitary tumers  sella  syndrome
🔹premature ovarian failure
🔹Pure gonadal dysgensis

#Good_Luck
@obstetricsgynecology1

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