JUVENILE BLEEDING Painful Profuse Bleeding After Suppression of Menses [Abnormal Irregular Bleeding] : After Menarche : Age 10-16 Years TREATMENT : Analgesics, Antispasmodics, Antiprostaglandine ANOVULAR MENSTRAL CYCLE Not Accompanied by Ovulation : One-phase Temperature Causes Infertility rertetor em nce min oo ce] =] 3 Ascending Infection Infection from Vulva to Urinary Bladder. Acute Vulvitis to Acute Cystitis. Signs: Frequent Low - volume, Painful Urination, Leukocyturia. Atrophic Colpitis Local Treatment: Vaginal Suppositories “Ovestin” dk cy www.mceqwithexplanation.com/ ky ‘Me With Eaplarntion S| A g = i] 3 & cy rf Ay Fy iS 2 a 8 a PMMA Ay CIETY Mey With Explanationwww.meq xplanation.co Paya | Hymen Atresia / Imperforated Hymen | Signs: Primary Amenorrhea, Cyclic Pain. www.meqwithexplanation.com/ , INFECTIONS TRICHOMONAS: Trichomonas Colpitis (Vaginitis) Profuse Foamy Vaginal Discharges, Burning & Itching in Genitalia, Foamy Leucorrhea in Urethra. Tactics: Treatment of Specific Colpitis with Biopsy Treatment: Metronidazole www.meqwithexplanation.com/ Herpes Infection: Vesicles filled with Clear Fluid, Itching & Burning. Acute Bartholinitis: Dense, Painful, Tumor - like Formations on Labia Majora. Candidal Vulvovaginitis: White Deposit accumulated in Folds, Swollen, Painful, External Genitalia, with Itching. Gardnerellosis Watery Vaginal Discharges, with Fish - like Smell Gram Stain smears With Clue Cells www.meqwithexplanation.com/com/ www.mequwithexplanation. ; ‘ _ 7 _i - | Obstruction of Uterine Tubes Treatment: Laparoscopy Pregnancy Tactics: In- vitro Fertilization. DAU Ue eu cLlA Acute Bilateral Adnexitis Signs: Fever, Purulent Discharges, Pain in Lower Abdomen. Exar in: Bacteriological & Bacterioscopic Analysis Causative Agent: Neisseria Gonorrhea (Diplococci) i " Wk S Krukenberg Tumor | Malignancy of Tumor in Ovary, from Primary Site (mainly GIT). History of Surgery of Gastric Ulcer. | Examination: Nodular Tumor in Hypogastrium, Tight Tumors with Uneven Surface on the Sides of Uterus. www.meqwithexplanation.com/ Douglas Pouch Area between Uterus & Rectum in Female Body. Diagnostic method for Abscess: Digital Rectal Examination. Meg With Explanation ‘Hey With Zaglenationwww.mcqwithexplanation.com/ TORSION Ovarian Tumor Pedicle Signs: Fever, Sharp Pain in Lower Abdomen Dense Elastic Formation in Ovary Ovarian Cyst with Pedicle Torsi History of Ovarian Cyst Signs: Fever, Acute Pain in Lower Abdomen occurring after Physical Stress. www.meqwithexplanation.com/ Rk CYSTS Stein Leventhal Syndrome Signs: Irregular Delayed Menstruations, Hirsutism, Infertility. Gynaecological Examination: Enlarged Ovaries, Compact/ Dense, Painless, Mobile. USG: Multiple Enlarged Follicles in Ovaries / Cystic Inclusions / Microcystic Changes. Endometrioid Cyst of Ovary Chocolate like Vaginal Discharge, Tumor - like Formations. Treatment: Surgical Laparoscopy www.meqwithexplanation.com/ a oe &Most Important Diagnostic Method in Gynaecology & Obstetrics ULTRASOUND Vomiting of Pregnancy Mild: Not more than 5 times a day. Moderate: 6 - 10 times a day. Seve! ill 20 times or more a day. ke ean Preeclampsia & Eclampsia id Preeclampsia: Diastolic B.P: 90 - 99mmHg. Proteinuria: <0.3g/day. Moderate Preeclampsia: Diastolic B.P: 100 - 109mmHg. Proteinuria: 0.3 - 5g/day. Severe Preeclampsia: Diastolic B.P: >110mmHg. Proteinuria: >5g/day. Eclampsia: Diastolic B.P: >90mmHg, Proteinuria, Along with Convulsive Attacks (without any history of Epilepsy) oe ccom/ Bh Incompatibility: When Mother is Rh -ve, Fetus is Rh +ve. History of Fetal Deaths (Abortions) Rise in Rh-Antibody Titer Several Times (1:64) Tactics: Early/ Premature Delivery (after 28th week) Antibodies should be determined Once a Week (after 35th Week) Complication: Fetal Liver Enlargement(Ultrasound for detection of Fetal location), Signs: Enlarged & Palpable, Painful Appendages (of one side only), (Normally Appendages are non Palpable) Elastic & Moderately Painful Formations. Morning Sickness, Gustatory Changes, Menstruation Delay Broken/Interrupted Tubal Pregnancy Dark Bloody Discharges, Positive Peritoneum Irritation Sudden Pain in the Lower Abdomen, Radiating to Anus ST geese eed Cervical Pregnancy Cervix is Cyanotic, Enlarged, Soft, Barrel Shaped. , Appendages are Unremarkable Qk hCG test is Positive. Placental Presentation [Placenta Previa] Placental Attachment Near Cervical Opening, covering it Marginally, Partially or Completely. During Manual Examination It Bleeds & can be Detached. eg www.mcquithexplanation.com/ auyatebeStages of Labour Stage 1: Dilation of Cervix Latent Stage: 0 - 3cm Dilation of Cervix Active Stage: 3 - 10cm Dilation of Cervix Stage 2: Expulsion of Fetus Stage 3: Postnatal Stage Expulsion of Placenta TREATMENT/ TACTICS IN LABOR COMPLICATION Outlet / Obstetrical Forceps / Forceps Operation: Fetal head is in the Pelvic Outlet / Floor Conditions - Primary Uterine Inertia - Preeclampsia Caesarean Section: Fetal Head is Engaged to Pelvic Inlet Conditions - Extended Pain in the Post Surgical Scar | - Placental Presentation + Greenish Colour of Amniotic Fluid - Contracted Pelvis (Vasten Sign) - Uterine Cervix is not Dilated - Weak Fetal Movements, Decreased HeartBeat, Backward Tilted Cervix - Transverse Position of Fetus Labour Stimulation After Preparation Oxytocin Test is Negative Jk, Episiotomy: Surgical Cut in the Perineum Sr . Signs: Perineum becomes Pale. Ome Wik EoCOMPLICATIONS Rupture of Uterus Stopped Labour Activity / Uterine Contractions, Positive Peritoneal Irritation Signs, Illdefined Uterus Lines. Threatened / Impending / Risk of Uterine Rupture (Hysterorrhexis) Contraction / Retracting Ring is at the Level of Navel Vasten Sign is Positive Uterine Inertia: Hypotonic Uterine Dysfunction Primary: Uterine Inertia occurs in the Beginning of the Labour (1st Stage). Signs: Cervical Dilation of <3cm in the Latent Phase of Labour Frequency of Contraction <2 in 10secs. Secondary: Uterine Inertia occurs in the 2nd Stage of Labour (Stage of Expulsion of Fetus). Discoordinated Labour Activity: Hypertonic Uterine Dysfunction Occurs Mostly in the Latent Phase of Labour (before Cervical Dilation of 4cm). jpastic Uterine Fauces, Increased Tone of Uterus. art of Fetus is Mobile, Pressed to the Pelvic Inlet. Placental Presentation Gk iy " Sudden, Painful Bloody Discharges, in 29th Week. maces Soft Formation defined through Anterior Fornix of Vagina Spontaneous Discharge of Amniotic Water, ihr before Starting of Actual Labour Activity Premature Detachment of Placenta / Placental Abruption Separation of Placenta from the Inner Wall of Uterus, before Birth. Signs: Morbid Uterus, Tense Abdomen, Fetal Heart Sounds are non Plapable Lok a ae i www.meqwithexplanation.com/www.mcqwithexplanation.com/ nf POST NATAL COMPLICATIONS _ Normally Placenta is Expelled Out After Child Birth. If Umbilical Cord drowns Back into Vagina & there are no symptoms of Placenta Detachment then Manual Removal of Placenta is carried out. Defect lacenta Tactics: Manual Revision of Uteri Atony of Uterus (Failure of Uterine Contraction) leads to Massive Bleeding After Child Birth & can cause Hemorrhagic Shock. History of Use of Oxytocin indicates Weak Uterine Contraction. If Post Natal Hypotonic Uterine Bleeding reaches up to 1.5% of Body Weight Conservative Methods are ineffective then, Private iaiests-areaiscad remote hte in Uterine Extirpation (Total Removal of Uterus, along with Cervix) [Note that Patient Already had Twins, so hysterectomy is not a Problem] POST NATAL INFECTIONS Endometritis Diffuse Peritonitis Inflammation of Endometrium | |Positive Peritoneal Irritation Sign Signs: Increased Body Temperature In all segments Uterus Enlarged, Dense, Slightly Painful. High Body Temperature. Discharges: Turbid,Foul Smell, Bloody & Pus Uterus: Painful Discharge: Blood & Pus Post Abortal: History of Abortion Preven ntibacterial Therapy Jk ee www.meqwithexplanation.com/www.mcqwithexplanati Cfo) PHYSIOLOGICAL INVOLUTIONAL CHANGES OF GENITALIA IN THE POSTNATAL PERIOD Time after Location of the Diameter delivery uterine fundus | of the placental platform, om Right after the | In the middle betwe- 12.5 Lochia rubra delivery en the umbilicus and (1-4 days) pubic symphysis The first day | On the level or a Lochia rubra little bit lower the umbilicus 7.5 cm above z Lochia serosal the pubic symphy- (5-9 days) sis Uterus is not pal- Lochia alba pated above the (10-15 days) pubic symphysis The sixth week | —“* — ‘ Usual Lochia Normal Uterine Blees www.mceqwithexplanation.com/ Uterus mass, g 900 450 200 100-200 60-100 Condition of the cervix Soff, smooth, 5 fin. gers are inserted Inserts 1-2 fingers Inserts 2 fingers Inserts 1 finger Uterine orifice is fissural 0.5% of the Body Weight Qk, augwww.meqwithexplanation.com/ Mastopathy Purulent / Suppurative Mastitis Signs: High Body Temperature, Fluctuation Present Painful, Enlarged, Hyperemic, Deformed Mammary Gland Types: Phlegmonous: Fluctuation, Hyperemia & Deformation in Large area Abscess/Infiltrative: Presence of Infiltrates, Soft in Centre. Fluctuation, Hyperemia & Deformation only over Infiltrates Treatment: Surgical Treatment Re uCe eae sese Lactational Mastitis Lactostasis (Hindered Milk Expression) & No Fluctuation High Fever, Pain & Enlargement of Mammary Gland. Treatment: Antibiotic, Immobilization & Expression of Milk | remem Fibrocystic Mastopathy: On Palpation Diffuse Nodes www.mequwithexplanation.com/ Fibrous Adenoma Painless, Dense, Mobile Growth With Even Borders US: Space Occupying Lesion of Increased Echogenicity Tactics: Surgical Removal of Tumor Prior Pregnancy Confirmational Diagnosis: Excision Biopsy “ Breast Cancer i Dense formation without clear/uneven margin, Long Subfebrile fever Inverted/Retracted Nipple, Skin Induration. Treatment T2N2MO Radiation Therapy + Operation + Chemotherapy www.mecqwithexplanation.com/A www.mceqwithexplanati Abortion Early Abortion: Before 12th Week of Pregnancy Late Abortion: Till 28th Week of Pregnancy x Spontaneous Abortion: Which occurs Spontaneously. at Induced Abortion (Done Artificially or Therapeutically) Indications: Pyelonephritis, Phlegmonous Appendicitis, Rubella. Types of Spontaneous Abortions Threatened Abortion (Risk of Abortion But not yet started) Abdominal pain, No-Bleeding or Discharge with Blood Streaks Inevitable Abortion / Abortion in progress Abdominal pain, Bloody Discharge Incipient Abortion Abdominal pain, Bloody Discharge with Cervical Dilation : 3 5 i 2 B g Bi A El 5 5 H a B 3 ig a 5 = Incomplete Abortion Discharge with Fertilised Ovum Fragments, Visible Gestational Sac Placental Tissue Remains in the Uterus, even after Bleeding. Tactics: Urgent Curettage of Uterine Cavity ‘Complete Abortion When whole Placental Tissue leaves the Uterus through Bleeding Uterus returns to its Normal Size. Isthmico - Cervical Insufficiency _ Dilation & Thinning or Shortening of Cervix before Labour. History of Previous Cervix Rupture & Spontaneous Abortions. Tactics: Suture on the Uterus Cervix Complication: Abortion or Preterm Birth. ok Tactics for Uterus Perforation: Probing of Uterine Cavity ay _ VK