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OB FINAL COACHING NOTES NOVEMBER 2023

1. Progesterone and Thick Cervical Mucus:
- Progesterone is a hormone produced during the menstrual cycle.
- It causes cervical mucus to become thick and sticky, making it difficult for sperm to pass through the cervix
and reach the uterus.
- This thickening of cervical mucus helps prevent fertilization during certain phases of the menstrual cycle.
MENSTRUAL CYCLE
The menstrual cycle is a complex, hormone-driven process that occurs in the female reproductive system,
typically lasting about 28 days (though it can vary). It involves various phases, each with distinct hormonal
changes and physiological events. Here are the key phases of the menstrual cycle:
1. Menstruation (Days 1-5):
The menstrual cycle begins with menstruation, commonly known as the period. During this phase, the uterine
lining (endometrium) that built up in the previous cycle is shed through the vagina.
Hormone levels, particularly estrogen and progesterone, are low at the start of menstruation.
2. Follicular Phase (Days 1-13):
Concurrent with menstruation, the hypothalamus in the brain releases gonadotropin-releasing hormone (GnRH),
stimulating the anterior pituitary gland to release follicle-stimulating hormone (FSH).
FSH prompts several ovarian follicles to start maturing, each containing an immature egg (oocyte).
One dominant follicle eventually emerges, and it continues to grow while others degenerate.
As the dominant follicle matures, it releases increasing amounts of estrogen, which stimulates the thickening of
the uterine lining in preparation for potential implantation.
3. Ovulation (Around Day 14):
Midway through the menstrual cycle, a surge in luteinizing hormone (LH) triggered by rising estrogen levels
causes the mature follicle to release its egg. This event is known as ovulation.
The released egg is captured by the fallopian tube and is available for fertilization.
Ovulation is a brief, fertile window when conception is most likely to occur.
4. Luteal Phase (Days 15-28):
After ovulation, the remnants of the ruptured follicle transform into a structure called the corpus luteum.
The corpus luteum secretes progesterone, which helps maintain the uterine lining for potential embryo
implantation.
If fertilization doesn't occur, the corpus luteum regresses, progesterone levels drop, and the uterine lining begins
to break down.
This drop in progesterone eventually triggers menstruation, and the cycle begins anew.
5. Secretory Phase (Part of Luteal Phase):
The early part of the luteal phase is sometimes called the "secretory phase" because of the increased secretion of
progesterone by the corpus luteum.
This hormone prepares the uterine lining for implantation by thickening it and increasing vascularization.
Ischemic Phase (Part of Luteal Phase):
Toward the end of the luteal phase, if fertilization doesn't occur, the corpus luteum regresses.
Progesterone levels decrease, causing a temporary reduction in blood flow to the uterine lining, leading to tissue
breakdown.
6. Menstruation (End of Luteal Phase):
The menstrual cycle ends with menstruation, which marks the beginning of a new cycle.
2. Oviducts and Pelvic Inflammatory Disease (PID):

- Oviducts, also known as fallopian tubes, are part of the female reproductive system.
- PID, or Pelvic Inflammatory Disease, is an infection of the female reproductive organs.
- PID often affects the oviducts, leading to inflammation and scarring.
- Oviduct damage can result in infertility or ectopic pregnancies, where a fertilized egg implants outside the
uterus.
3. Ectopic Pregnancy:
- An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, often in a fallopian
tube.
- Left-sided pain can be a symptom, but symptoms can vary, including abdominal pain, vaginal bleeding, and
discomfort.
FINAL COACHING NOTES NOVEMBER 2023 STARS NKL REVIEW SERVICES AND CONSULTANCY Page 1
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4. Crowning and Ritgen's Maneuver:

- Crowning is the stage of childbirth when the baby's head starts to emerge from the vaginal opening.
- Ritgen's Maneuver is a technique used to protect the perineum (the area between the vagina and anus) during
crowning.
- It involves applying gentle upward pressure to guide the baby's head and prevent tearing of the perineum.
5. Engagement in Childbirth:
- Engagement refers to when the baby's head descends into the mother's pelvis during childbirth.
- It is a sign that labor is progressing, and the baby is getting ready for delivery.
6. Cephalic Prominence:
- Cephalic prominence typically refers to the baby's head becoming visible during childbirth, indicating that the
baby is in the correct position for delivery.
7. Battledore Insertion of the Umbilical Cord:

- A "battledore" insertion means that the umbilical cord is attached to the edge of the placenta rather than the
center.
- It can be associated with a slightly higher risk of complications during pregnancy and childbirth.
8. Placenta Accreta:
- Placenta accreta is a condition in which the placenta is deeply implanted into the uterine wall.
- This can make it challenging to remove the placenta after childbirth and may lead to bleeding complications.
9. Succenturiate Placenta:
- Succenturiate placenta is a condition in which the placenta has one or more additional lobes connected to
the main placenta by blood vessels.
- This condition can increase the risk of postpartum bleeding.
10. Circumvallate Placenta:

- Circumvallate placenta is characterized by a central depression or raised ring-like edge on the placental
surface.
- It can be associated with pregnancy complications.
11. McRoberts Maneuver:

- McRoberts maneuver is a medical technique used during childbirth to resolve shoulder dystocia, which is a
complication where the baby's head has passed through the birth canal, but the shoulders become stuck behind
the mother's pelvic bone.
- During the McRoberts maneuver, the mother's legs are flexed tightly against her abdomen. This action
changes the angle of the pelvis, facilitating the release of the baby's shoulder and allowing for successful
delivery.
12. Mauriceau's Maneuver:

- The Mauriceau-Smellie-Veit maneuver is employed during breech deliveries to assist in delivering the baby's
head.
- This maneuver involves applying gentle traction to the baby's head while supporting it with the palm of the
hand to guide it through the birth canal.
13. Obstetric Conjugate:

- The obstetric conjugate is the narrowest anteroposterior (AP) diameter of the pelvic inlet.
- It is a crucial measurement in obstetrics because it determines whether a baby can pass through the birth canal
safely.
- Obstetric conjugate measurement is obtained by subtracting the diagonal conjugate (measured from the sacral
promontory to the posterior surface of the pubic symphysis) from the true conjugate (measured from the sacral
promontory to the inner surface of the pubic symphysis).
14. Heartburn Management:

- Heartburn, Pyrosis, or gastroesophageal reflux disease (GERD), can be managed through dietary and lifestyle
changes.
- Recommendations include avoiding triggers such as greasy and fatty foods, as well as acidic or spicy foods.
- Magnesium and aluminum hydroxide-based antacids can help neutralize stomach acid.
- Eating small, frequent meals and avoiding lying down immediately after eating can also alleviate symptoms.
15. HBMR and Panel 2:

- HBMR-detection of high risk, Panel 2 danger signs of pregnancy
16. Condylomata Acuminata (HPV):

- Condylomata acuminata, often caused by human papillomavirus (HPV) infection, leads to the development of
genital warts.
- These warts have a characteristic cauliflower-like appearance.
- HPV is a sexually transmitted infection, and the warts can appear in the genital area or around the anus.
17. Bacterial Vaginosis and Clue Cells:

- Bacterial vaginosis (BV) is a common vaginal infection characterized by an imbalance of the normal vaginal
flora, leading to an overgrowth of certain bacteria.
- Clue cells are epithelial cells from the vaginal lining covered with bacteria, making them appear stippled
or speckled when viewed under a microscope.
- The presence of clue cells is a diagnostic criterion for BV.
18. Candidiasis (Moniliasis):

- Candidiasis, often referred to as a yeast infection, is characterized by a thick, white, cottage cheese-like
vaginal discharge.
- It is typically accompanied by itching and discomfort in the genital area.
- A fishy odor is not commonly associated with candidiasis but is more characteristic of bacterial vaginosis.
19. Threatened Abortion:

- Threatened abortion is a term used when a pregnant woman experiences vaginal bleeding, but the cervix
remains closed, and fetal heart rate (FHR) is still detectable.
- This condition indicates a potential risk of miscarriage, but it may or may not progress to a complete
miscarriage.
20. Inevitable Abortion:

- Inevitable abortion is a condition where the cervix is open, and there is no fetal heart rate (FHR) detected.
- This suggests an impending miscarriage that cannot be prevented.
21. Breast Engorgement Management:

- Breast engorgement is the painful swelling of the breasts due to an excess of milk production.
- Management involves continuing breastfeeding to empty the breasts completely and frequently.
- Keeping the breasts clean and dry can also help relieve engorgement.
22. Diaper Rash Management:

- Diaper rash management includes keeping the baby's diaper area clean and dry.
- Using water or gentle wipes to clean the area, and applying diaper cream or ointment as needed can prevent
or treat diaper rash.
23. Medical eligibility criteria for contraceptive use

MEDICAL ELIGIBILITY CRITERIA
Medical eligibility criteria for contraceptive use are guidelines established by healthcare organizations, such as
the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), to help
healthcare providers assess the suitability of various contraceptive methods for individuals based on their
medical conditions and health status. These criteria help ensure the safe and effective use of contraceptives while
minimizing potential risks.
1. Category 1: No Restriction:
Contraceptive methods can be used with no restrictions or concerns. There are no known medical conditions that
would contraindicate their use.
2. Category 2: Advantages Generally Outweigh Risks:
Contraceptive methods can be used, and the advantages generally outweigh the risks. The method can usually be
used safely, but healthcare providers should consider individual circumstances.
3. Category 3: Risks Usually Outweigh Advantages:
Contraceptive methods may have potential risks that usually outweigh the advantages for individuals with certain
medical conditions. The method's use may not be recommended, but healthcare providers can consider specific
situations.
4. Category 4: Unacceptable Health Risk:
Contraceptive methods are not recommended due to unacceptable health risks for individuals with certain
medical conditions. The risks are considered too high, and alternative methods should be explored.
24. Proliferative Phase (Estrogen):

- In the menstrual cycle, the proliferative phase is driven by rising estrogen levels.
- During this phase, the uterine lining thickens in preparation for a potential pregnancy.
25. Corticosteroids for Lung Maturity:

- Corticosteroids like betamethasone or dexamethasone are administered to pregnant women at risk of preterm
birth.
- These drugs help mature the baby's lungs, reducing the risk of respiratory distress syndrome in premature
infants.
26. Lecithin/Sphingomyelin (LS) Ratio:

- The LS ratio is used to assess fetal lung maturity.
- A ratio of 2:1 or higher indicates that the fetal lungs are likely mature and can function properly after birth.
27. Bartholomew's Rule:

- Bartholomew's rule provides approximate fundal height landmarks during pregnancy to estimate gestational
age.
- These landmarks include the symphysis at 12 weeks, the umbilicus (navel) at 20 weeks, and the xiphoid
process at 36 weeks.
BARTHOLOMEW'S RULE provides the following landmarks for fundal height during pregnancy:
1. Symphysis Pubis: At around 12 weeks of pregnancy, the top of the uterus (fundus) is typically at the level of the
pubic symphysis.
2. Umbilicus (Navel): At approximately 20 weeks of pregnancy, the fundus is typically at the level of the umbilicus or
navel.
3. Xiphoid Process: By about 36 weeks of pregnancy, the fundus reaches the level of the xiphoid process, which is
the lower part of the sternum (breastbone).
28. Partograph and Cervical Dilatation:

- A partograph is a tool used to monitor the progress of labor.
- If the cervical dilatation on the partograph crosses the right of action line, it indicates a deviation from the
normal labor curve.
- Referral for further evaluation or intervention is recommended when this occurs.
- Plotting on the partograph typically begins during the active phase of labor, which is often when the cervix is
around 4 cm dilated.
29. Lochia on the Second Day (Lochia Rubra):

- Lochia is the vaginal discharge that occurs after childbirth.
- Lochia rubra is the initial stage, characterized by bright red bleeding during the first few days postpartum.
Types of Lochia:
Lochia typically goes through different stages, each with its own characteristics.
1. Lochia Rubra: This is the initial discharge and is usually bright red in color. It contains blood, mucus, and uterine
tissue debris. Lochia rubra can last for a few days to a week or more after childbirth.
2. Lochia Serosa: After lochia rubra, the discharge transitions to a pink or brownish color. This stage can last for a
week or two.
3. Lochia Alba: Lochia alba is the final stage, characterized by a yellowish-white or creamy discharge. It can persist
for several weeks and gradually fades away.
30. Laceration and 4th Degree Tears:

- Lacerations during childbirth are classified by degrees, with a 4th-degree laceration being the most severe.
- A 4th-degree tear extends through the vaginal and anal sphincters, including the rectal mucosa.
DEGRESS OF LACERATION
A perineal laceration is a tear or injury that occurs in the perineum, which is the area of tissue located between
the vaginal opening and the anus. Perineal lacerations can occur during childbirth and are relatively common.
They are classified into different degrees based on their severity:
1. First-Degree Laceration: This is the mildest form of perineal laceration. It involves only the vaginal mucosa and
the perineal skin. First-degree lacerations are generally minor and often do not require sutures but may be
repaired if necessary.
2. Second-Degree Laceration: A second-degree laceration involves the vaginal mucosa, perineal skin, and the
muscles of the perineum, known as the perineal body. These lacerations are more extensive than first-degree
tears and usually require sutures for repair.
3. Third-Degree Laceration: A third-degree laceration extends beyond the vaginal mucosa, perineal skin, and
muscles to include the anal sphincter. Repair of third-degree lacerations is essential to prevent complications and
promote proper healing.
4. Fourth-Degree Laceration: This is the most severe type of perineal laceration. It involves the vaginal mucosa,
perineal skin, muscles, and the anal sphincter, extending through the rectal mucosa. Fourth-degree lacerations
require careful repair to ensure proper healing and minimize complications.
31. Sources of Iron (Liver, Dark Green Leafy Vegetables):

- Iron is an essential mineral for the body, particularly important for preventing anemia, especially during
pregnancy.
- Liver and dark green leafy vegetables are dietary sources of iron.
- Consuming iron-rich foods is essential for maintaining healthy iron levels in the body, especially during
pregnancy when iron demands increase.
32. Leopold's Maneuver and Attitude (4th Maneuver):

- Leopold's maneuvers are a series of four maneuvers used to assess the position and presentation of the fetus
during pregnancy.
- The fourth maneuver involves determining the fetal attitude, which refers to the relationship between the fetal
parts, such as the head and body.
- A cephalic presentation, where the baby's head is down, is considered a favorable fetal attitude for a normal
vaginal delivery.
LEOPOLD'S MANEUVERS:
1. First Maneuver: This involves palpating the upper abdomen to determine the location of the fetal head. It helps
identify whether the baby's head is in the fundus or in another position.
2. Second Maneuver: During the second maneuver, the healthcare provider feels for the back of the fetus to
determine its position. They can determine whether the baby's back is on the mother's left side or right side.
3. Third Maneuver: In the third maneuver, the provider explores the lower abdomen to assess which fetal part
(either the head or buttocks) occupies the pelvic inlet. This helps determine engagement.
4. Fourth Maneuver: The fourth and final maneuver involves assessing fetal attitude, which refers to the
relationship between the fetal parts, such as the head and body, to determine if the baby is in a cephalic
presentation (head-first) or a different presentation, such as a breech presentation.
33. Pseudocyesis (False Pregnancy):

- Pseudocyesis, also known as false pregnancy, is a psychological condition in which an individual experiences
many pregnancy-like symptoms despite not being pregnant.
- Common symptoms include amenorrhea (lack of menstruation), nausea, and perceived uterine growth.
- Pseudocyesis can be associated with strong beliefs or desires for pregnancy and may involve physical and
emotional changes mimicking pregnancy.
34. Types of Contraceptives (Irreversible vs. Long-Term Reversible):

- "Irreversible" contraception typically refers to permanent methods like Bilateral Tubal Ligation (BTL), where
the fallopian tubes are surgically closed to prevent pregnancy permanently.
- "Long-term reversible" contraception includes methods like the Intrauterine Device (IUD), which can be
removed when a person desires to become pregnant.
35. Postpartum Family Planning Methods (LAM, IUD, POP):

- Postpartum family planning methods are used to prevent pregnancy after childbirth.
- Lactational Amenorrhea Method (LAM) relies on breastfeeding to prevent ovulation.
- Intrauterine Devices (IUDs) can be inserted shortly after childbirth and provide long-term contraception.
- Progestin-Only Pills (POP) are birth control pills that can be taken postpartum, especially for breastfeeding
mothers.
36. Postpartum Hemorrhage Cause (Boggy Uterine Atony):

- Postpartum hemorrhage (PPH) is excessive bleeding after childbirth.
- Boggy uterine atony occurs when the uterus does not contract effectively after delivery, leading to excessive
bleeding.
- Prompt management of uterine atony is crucial to prevent and control postpartum hemorrhage.
37. PIH, Eclampsia, and Magnesium Sulfate:

- PIH stands for Pregnancy-Induced Hypertension, a condition where high blood pressure develops during
pregnancy.
- Eclampsia is a severe complication of PIH characterized by convulsions.
- Magnesium sulfate (MgSO4) is used to prevent and treat eclamptic seizures in individuals with PIH or
eclampsia.
38. Abruptio Placenta:

- Abruptio placenta is a medical condition where the placenta separates from the uterine wall before childbirth.
- Symptoms often include dark red vaginal bleeding and a board-like or tense abdomen.
- It can be a life-threatening emergency for both the mother and the baby.
39. Glucose Challenge Test for Gestational Diabetes (Performed at 24-28 Weeks):
- The glucose challenge test is a screening test for gestational diabetes.
- It is typically performed between 24 and 28 weeks of pregnancy to assess glucose tolerance.
- Abnormal results may indicate the need for further diagnostic testing.
Glucose Challenge Test (GCT)

The Glucose Challenge Test (GCT) is a screening test used during pregnancy to assess a woman's risk of
developing gestational diabetes mellitus (GDM). Gestational diabetes is a type of diabetes that occurs during
pregnancy and can affect both the mother and the baby. The GCT is typically performed between the 24th and
28th weeks of pregnancy, although the timing may vary based on individual healthcare provider
recommendations.
Purpose: The GCT is used to identify pregnant women who may have an increased risk of gestational diabetes. It
is a preliminary screening test and not a definitive diagnosis of gestational diabetes.
Test Procedure:
1. The pregnant woman is asked to fast overnight (usually for at least 8 hours) to ensure accurate test results.
2. In the morning, the woman arrives at the healthcare provider's office or laboratory.
3. A baseline blood sample is drawn to measure the fasting blood sugar level.
4. The woman is then given a sweet glucose drink containing a standardized amount of glucose (usually 50 grams). It
may be flavored with orange or another pleasant taste.
5. After drinking the glucose solution, the woman typically waits for about one hour.
6. After the one-hour waiting period, another blood sample is drawn to measure the blood sugar level.
Interpretation:
1. The results are usually available on the same day. They are reported in milligrams of glucose per deciliter of blood
(mg/dL).
2. A cutoff value is used to determine whether the test is normal or abnormal. In most cases, a one-hour blood
sugar level of 140 mg/dL or higher is considered abnormal and may require further testing.
3. If the result is below the cutoff value, it is considered normal, and no further testing for gestational diabetes may
be necessary.
40. Estrogen and Thickening of the Endometrium:

- Estrogen is a female sex hormone responsible for thickening the endometrial lining of the uterus during the
menstrual cycle.
- The thickened endometrium provides a suitable environment for a potential fertilized egg to implant and
develop into a pregnancy.
MENSTRUAL CYCLE
Estrogen and progesterone are two key hormones that play crucial roles in the menstrual cycle, which is the
hormonal and physiological process that prepares the female reproductive system for potential pregnancy each
month. These hormones are produced by the ovaries and have distinct functions during different phases of the
menstrual cycle:
Follicular Phase:
• This is the first half of the menstrual cycle, which begins on the first day of menstruation and lasts until
ovulation.
• Estrogen: Early in the follicular phase, estrogen levels start to rise. Estrogen is responsible for stimulating
the growth and development of ovarian follicles, each of which contains an immature egg (oocyte).
• As the follicles mature, they produce increasing amounts of estrogen. This hormone also has an impact on
the thickening of the uterine lining (endometrium) in preparation for potential implantation of a fertilized
egg.
Ovulation:
• Ovulation is a brief phase when a mature follicle releases an egg from the ovary. This release is triggered
by a surge in luteinizing hormone (LH), which occurs due to rising estrogen levels.
Luteal Phase:
• After ovulation, the empty follicle transforms into a structure called the corpus luteum.
• Progesterone: The corpus luteum primarily secretes progesterone during the luteal phase. Progesterone
is responsible for preparing the uterine lining for potential implantation of a fertilized egg.
• Progesterone also helps maintain the uterine lining and inhibits further follicular development,
preventing the release of additional eggs during the current cycle.
• If fertilization and embryo implantation occur, the corpus luteum continues to produce progesterone to
support early pregnancy. If not, the corpus luteum regresses, leading to a drop in progesterone levels.
Menstruation:
• If pregnancy does not occur, the decrease in both estrogen and progesterone levels triggers
menstruation, which marks the end of one menstrual cycle and the beginning of another.
41. Estrogen and Thin Cervical Mucus:

- Estrogen is also responsible for making cervical mucus thin, clear, and more hospitable to sperm.
- Thin cervical mucus facilitates the movement of sperm through the cervix, aiding in conception.
42. Precipitate Labor Management:

- Precipitate labor is an extremely fast labor and delivery process.
- Management includes helping the mother with rapid breathing techniques and, if necessary, ensuring that she
does not push until it's safe to do so under medical supervision.
43. Uterine Involution:

- Uterine involution is the process by which the uterus returns to its pre-pregnancy size and shape after
childbirth.
- It is primarily driven by uterine contractions that help expel excess blood and tissue from the uterine cavity.
44. After Pains (More Common in Multiparas):

- After pains, also known as uterine contractions, can be felt during the postpartum period.
- These contractions help the uterus return to its normal size and shape.
- They can be more pronounced in multiparous women (those who have given birth multiple times) due to
increased uterine muscle tone.
45. Protection during Pregnancy after Tetanus Toxoid (TT):

- To protect against certain infections during pregnancy, women should receive at least two doses of the tetanus
toxoid (TT) vaccine.
- This vaccine helps prevent tetanus, a potentially life-threatening bacterial infection.
46. Station and Non-Palpable Ischial Spine:

- The station refers to the level of the baby's head in the birth canal.
- "Non-palpable ischial spine" means that the baby's head has descended to the level of the ischial spine and
can often be felt during a vaginal examination.
- This is a crucial assessment in labor to determine the baby's position and progress.
FETAL STATION
Fetal station is measured in centimeters above or below an imaginary line known as the "ischial spines," which
are bony landmarks in the mother's pelvis. The ischial spines are typically used as a reference point because they
are relatively fixed in position.
• "Engagement" or "Zero Station": When the presenting part of the baby (usually the head) is at the level of the
ischial spines, it is referred to as "engaged" or "zero station." This is the lowest position of the baby in the pelvis,
and it indicates that the baby's head has descended into the mother's pelvis. Engagement is a significant
milestone in labor and suggests that the baby is well-positioned for delivery.
• "Minus Station" or "Above the Ischial Spines": If the presenting part of the baby is still above the level of the
ischial spines, it is described as being at a "minus station." For example, if the baby's head is 2 cm above the
ischial spines, it is referred to as "-2 station."
• "Plus Station" or "Below the Ischial Spines": If the presenting part of the baby has descended below the level of
the ischial spines, it is described as being at a "plus station." For example, if the baby's head is 2 cm below the
ischial spines, it is referred to as "+2 station."
47. Menstruation and Withdrawal of Progesterone:

- Menstruation occurs when there is a drop in progesterone levels.
- Progesterone maintains the thickness of the endometrial lining (uterine lining), and its withdrawal triggers the
shedding of this lining, resulting in menstrual bleeding.
48. Umbilical Vein and Highly Oxygenated Blood:

- The umbilical vein carries highly oxygenated blood from the placenta to the fetus.
- This oxygenated blood provides the developing fetus with oxygen and essential nutrients for growth and
development.
FETAL CIRCULATION
During fetal circulation, there are several special shunts or circulatory pathways that allow blood to bypass
certain non-functional fetal organs and optimize the distribution of oxygenated blood. Fetal circulation is unique
because oxygen exchange primarily occurs in the placenta, not the lungs, as the fetus does not breathe air. Here
are the key special shunts and circulatory pathways in fetal circulation:
• Ductus Venosus:
The ductus venosus is a short vessel located in the fetal liver that connects the umbilical vein to the inferior vena
cava.
Its function is to shunt oxygenated blood from the placenta directly into the fetal inferior vena cava, bypassing
the liver.
This ensures that oxygen-rich blood reaches the heart more efficiently.
• Foramen Ovale:
The foramen ovale is an opening between the two atria (upper chambers) of the fetal heart.
It allows most of the oxygenated blood returning from the placenta to pass from the right atrium to the left
atrium, avoiding the pulmonary circulation.
This bypasses the non-functional fetal lungs, which are filled with amniotic fluid, and directs oxygenated blood
into the systemic circulation.
• Ductus Arteriosus:
The ductus arteriosus is a short, muscular vessel that connects the pulmonary artery to the aorta in the fetal
heart.
It allows a portion of the blood pumped by the right ventricle to bypass the pulmonary circulation and flow
directly into the systemic circulation.
This further reduces the amount of blood going to the non-functional fetal lungs.
49. Secretory Phase and Progesterone:

- The secretory phase of the menstrual cycle is characterized by the dominance of progesterone.
- Progesterone prepares the uterine lining for potential implantation by thickening it and creating a hospitable
environment for a fertilized egg.
50. Oxytocic (Uterotonic) Drugs:

- Oxytocic or uterotonic drugs are medications used to stimulate uterine contractions during labor.
- They help facilitate the progression of labor and the delivery of the baby.
- Examples include oxytocin and methergine.
UTEROTONIC DRUGS
Uterotonic drugs are medications that are used to stimulate contractions of the uterus (womb). They are
commonly employed in obstetrics and gynecology for various purposes, including inducing or augmenting labor,
preventing or managing postpartum hemorrhage (excessive bleeding after childbirth), and facilitating the
expulsion of the placenta after delivery. Uterotonic drugs work by promoting uterine muscle contractions.
1. Oxytocin: Oxytocin is a natural hormone produced by the body and plays a significant role in uterine contractions
during labor. Synthetic oxytocin (Pitocin or Syntocinon) is commonly used in medical settings to induce labor,
augment contractions during labor, and prevent or treat postpartum hemorrhage. It is administered
intravenously under medical supervision.
2. Ergonovine: Ergonovine is a medication that can help prevent or treat postpartum hemorrhage by causing uterine
contractions. It is usually given as an injection after childbirth.
3. Methylergonovine: Similar to ergonovine, methylergonovine is used to prevent or manage postpartum
hemorrhage by promoting uterine contractions. It is typically administered as an injection after delivery.
4. Misoprostol: Misoprostol is a synthetic prostaglandin E1 analogue. It can be used to induce labor, especially in
cases of fetal demise or medical indications. It can also be administered to prevent or manage postpartum
hemorrhage. Misoprostol is available in tablet form and can be taken orally or used vaginally.
5. Carboprost Tromethamine: Carboprost tromethamine (Hemabate) is a synthetic prostaglandin analogue used to
prevent or treat postpartum hemorrhage when other measures are ineffective. It is typically administered as an
injection into a muscle.
6. Prostaglandin E2 (Dinoprostone): Dinoprostone is a medication that can be used to ripen the cervix in
preparation for labor induction. It comes in various forms, including gel, suppository, and vaginal insert. It can
also be used to induce labor or manage postpartum hemorrhage.
7. Prostaglandin F2α (Dinoprost): Dinoprost is used to induce labor and, in some cases, to evacuate the uterus
during the second trimester of pregnancy if needed.
8. Rho(D) Immune Globulin: While not a uterotonic drug in the traditional sense, Rho(D) immune globulin is
sometimes administered after childbirth to Rh-negative mothers who have given birth to Rh-positive babies to
prevent the development of Rh sensitization and related complications in future pregnancies.
51. Sago-Like Discharges, Choriocarcinoma, and Methotrexate:

- Sago-like discharges may refer to certain symptoms associated with choriocarcinoma, a rare cancer that can
develop from trophoblastic tissue.
- Trophoblastic tissue originates from the placenta or the tissue surrounding a fertilized egg.
- Methotrexate is a medication that can be used to treat choriocarcinoma.
52. PID and Contraceptive Use (Category 4):

- Pelvic Inflammatory Disease (PID) is a contraindication (category 4) for the use of intrauterine devices
(IUDs) or certain contraceptives.
- This is because using such methods in the presence of PID can potentially worsen the infection.
53. Purulent Discharges and Gonorrhea:

- Purulent discharges, characterized by the presence of pus-like fluid, can be a symptom of gonorrhea, a
sexually transmitted infection (STI).
- Gonorrhea is caused by the bacterium Neisseria gonorrhoeae and can lead to various symptoms, including
purulent discharges.
54. Common Causes of PID (Chlamydia Trachomatis and Gonorrhea):

- Chlamydia trachomatis and Neisseria gonorrhoeae are two of the most common bacterial causes of Pelvic
Inflammatory Disease (PID).
- These STIs can lead to inflammation and infection of the female reproductive organs.
SEXUALLY TRANSMITTED INFECTIONS (STIS) can have serious consequences during pregnancy, both
for the pregnant person and the developing fetus. Here is a summary of the most common STIs during
pregnancy:
1. Chlamydia:
Chlamydia is one of the most prevalent STIs among pregnant women. It is caused by the bacterium Chlamydia
trachomatis.
Complications during pregnancy include preterm birth, low birth weight, and neonatal conjunctivitis or
pneumonia if the newborn is exposed during childbirth.
Screening and prompt treatment are crucial to prevent complications.
2. Gonorrhea:
Gonorrhea is another common bacterial STI that can affect pregnant women. It is caused by the bacterium
Neisseria gonorrhoeae.
Similar to chlamydia, untreated gonorrhea during pregnancy can lead to preterm birth, low birth weight, and
neonatal infections.
Screening and treatment are essential for pregnant individuals with gonorrhea.
3. Human Papillomavirus (HPV):
HPV is a viral STI that includes various strains. Some strains can cause genital warts, while others are linked to
cervical cancer.
During pregnancy, HPV does not typically affect the fetus. However, genital warts can proliferate due to hormonal
changes.
Routine Pap smears and HPV testing are recommended during pregnancy to monitor for abnormal cervical
changes.
4. Herpes Simplex Virus (HSV):
HSV can cause genital herpes, and it is caused by two types of herpes viruses: HSV-1 and HSV-2.
If a pregnant person has an active genital herpes outbreak near the time of delivery, there is a risk of transmitting
the virus to the newborn, which can be severe or fatal.
Antiviral medications and, in some cases, a cesarean section may be recommended to reduce the risk of
transmission.
5. Syphilis:
Syphilis is a bacterial STI caused by Treponema pallidum.
If left untreated, syphilis can lead to congenital syphilis, which can cause stillbirth, preterm birth, low birth
weight, and a range of severe health problems in the newborn.
Routine syphilis screening during pregnancy is essential, and treatment with penicillin can prevent transmission to
the fetus.
6. HIV:
Human Immunodeficiency Virus (HIV) is a viral STI that can lead to Acquired Immunodeficiency Syndrome (AIDS).
Pregnant individuals with HIV can transmit the virus to their babies during pregnancy, childbirth, or breastfeeding.
Antiretroviral therapy (ART) during pregnancy and other preventive measures can greatly reduce the risk of
transmission to the newborn.
55. Jagged Tears and Laceration:

- Jagged tears or lacerations can occur in the genital area during childbirth.
- Lacerations are classified by degrees, with higher degrees indicating more severe tears.
56. Leopold's Maneuver and Fetal Attitude (4th - Cephalic Prominence):

Leopold's maneuvers are a series of four external abdominal palpations performed by healthcare providers to
assess the position and presentation of the fetus during pregnancy.
The fourth maneuver involves assessing fetal attitude, which refers to the relationship between the fetal parts,
particularly the head and body. It helps determine if the baby is in a cephalic presentation, meaning that the
baby's head is positioned to be delivered first during childbirth.
57. BMI of 40 (Morbidly Obese):

• A Body Mass Index (BMI) of 40 or higher is classified as "morbidly obese."
• Morbid obesity indicates a significantly increased risk of health problems related to excessive body weight, such
as cardiovascular diseases, diabetes, joint issues, and more. It's an important indicator for healthcare providers to
assess a person's health.
Body Mass Index (BMI) is a numerical value calculated from a person's height and weight. It is a widely used
tool for assessing whether an individual has a healthy body weight relative to their height. BMI is often used as a
screening tool to categorize people into different weight categories, which can provide an initial assessment of
the risk of various health conditions associated with weight.
BMI CATEGORIES:
1. Underweight: BMI less than 18.5
Individuals in this category may be undernourished or have a low body weight for their height.
2. Normal Weight: BMI between 18.5 and 24.9
This is considered a healthy weight range for most people, indicating a balanced relationship between weight and
height.
3. Overweight: BMI between 25 and 29.9
People in this category have excess body weight relative to their height, which may increase the risk of certain
health conditions.
4. Obesity Class I: BMI between 30 and 34.9
This is the first level of obesity and is associated with a higher risk of obesity-related health issues.
5. Obesity Class II: BMI between 35 and 39.9
This is the second level of obesity and indicates a higher risk of health problems.
6. Morbid Obesity: BMI of 40 or higher

This is the most severe level of obesity and is associated with a significantly increased risk of serious health
conditions.
58. Oligohydramnios and Cause (Kidney Agenesis/Renal Agenesis):

• Oligohydramnios is a medical condition characterized by a reduced volume of amniotic fluid surrounding the fetus
during pregnancy.
• One possible cause of oligohydramnios is kidney agenesis or renal agenesis, a condition in which the baby has
either missing or underdeveloped kidneys.
• These underdeveloped or absent kidneys may result in reduced urine production, leading to a deficiency of
amniotic fluid in the womb.
1. Partograph: A partograph is a comprehensive graphical recording tool used in obstetrics to closely monitor and
track the progress of labor. It is a critical document that includes information such as the mother's vital signs
(e.g., blood pressure, pulse rate, temperature), cervical dilation and effacement, fetal heart rate, and frequency
and strength of contractions. The partograph helps healthcare providers identify any deviations from the normal
course of labor, allowing for timely intervention and improved maternal and fetal outcomes.
2. Stages of Labor: Labor is typically divided into three main stages:
a. First Stage: This stage involves the onset of labor contractions and the progressive dilation and effacement of
the cervix. It is further divided into three phases: latent (early contractions with slow cervical changes), active
(rapid cervical dilation), and transition (completion of cervical dilation to 10 cm).
b. Second Stage: The second stage begins when the cervix is fully dilated and ends with the birth of the baby.
This stage involves active pushing efforts by the mother.
c. Third Stage: The third stage starts immediately after the birth of the baby and concludes with the delivery of
the placenta.
3. Phases of the First Stage of Labor: The first stage of labor can be described in three phases:
a. Latent Phase: In the latent phase, contractions are typically mild and irregular. Cervical dilation progresses
slowly. This phase is characterized by early labor and often involves the early effacement of the cervix.
b. Active Phase: The active phase is marked by more regular and intense contractions, resulting in faster
cervical dilation. This phase is a critical juncture in labor, and the mother may experience increased discomfort.
c. Transition Phase: The transition phase represents the final push to complete cervical dilation (10 cm).
Contractions are strong and frequent, and this phase is often accompanied by intense pain and a feeling of
urgency. It precedes the beginning of the second stage of labor.
4. Chadwick's Sign: Chadwick's sign is a bluish discoloration of the cervix, vagina, and vulva that occurs as early
as the sixth week of pregnancy. It results from increased blood flow and vascular changes in the pelvic area due
to hormonal shifts, particularly elevated estrogen levels.
5. Melasma: Melasma is a common dermatological condition that presents as symmetrical, brown or gray-brown
patches on the face, particularly on the cheeks, forehead, and upper lip. It is often referred to as the "mask of
pregnancy" because it frequently occurs during pregnancy due to hormonal changes, primarily increased melanin
production in response to sun exposure.
6. Waddling Gait: A waddling gait is an altered walking pattern observed in some pregnant individuals,
particularly in the later stages of pregnancy. It is characterized by a swaying motion of the hips and a wider
stance. This gait is a result of the loosening of pelvic ligaments and the shifting center of gravity caused by the
growing uterus.
7. Abruptio Placenta: Abruptio placenta is a serious obstetric complication where the placenta prematurely
detaches from the uterine wall before the baby's birth. This condition can lead to heavy bleeding, abdominal pain,
and fetal distress, posing significant risks to both the mother and the baby.
8. Placenta Previa: Placenta previa is a condition in which the placenta partially or completely covers the cervix,
obstructing the baby's passage through the birth canal. This condition can lead to painless vaginal bleeding and
often necessitates a cesarean section delivery to prevent complications.
9. Cullen's Sign: Cullen's sign is a clinical manifestation characterized by bruising or discoloration around the
umbilicus (belly button). It is an important indicator of intra-abdominal bleeding and can be associated with
serious medical conditions such as ruptured ectopic pregnancy, pancreatitis, or traumatic injury.
10. Signs of Shock: Signs of shock in pregnant individuals may include rapid heart rate (tachycardia), low blood
pressure (hypotension), cold and clammy skin, altered mental status, weak or thready pulses, and decreased urine
output. Shock can result from various causes, including hemorrhage or severe infection during pregnancy.
11. After Pain: After pains are uterine contractions that occur in the postpartum period as the uterus returns to its
pre-pregnancy size and position. These contractions can be uncomfortable and are more noticeable during
breastfeeding as they help expel blood clots and reduce uterine bleeding.
12. Involution Uterine: Uterine involution is the physiological process by which the uterus returns to its non-
pregnant size and position after childbirth. This process involves the shrinking of the uterine muscle and the
shedding of the uterine lining.
13. Mastitis: Mastitis is an inflammatory condition of the breast tissue that can occur in breastfeeding mothers. It
is often caused by infection, leading to symptoms such as breast pain, redness, swelling, warmth, and sometimes
fever. Prompt treatment with antibiotics is typically necessary.
14. Fetal Distress: Fetal distress refers to a situation during labor or delivery where the fetus is not receiving
sufficient oxygen or nutrients. It can be indicated by abnormal fetal heart rate patterns, such as decelerations or
tachycardia, and may require immediate medical intervention.
15. Salpingitis: Salpingitis is the medical term for inflammation or infection of the fallopian tubes. It is
frequently caused by sexually transmitted infections (STIs) and can lead to pelvic inflammatory disease (PID),
which can result in fertility problems if left untreated.
16. Human Papillomavirus (HPV): Human papillomavirus (HPV) is a common sexually transmitted virus that
can cause genital warts and is linked to various types of cancer, including cervical cancer. HPV vaccines are
available to protect against some of the most harmful strains.
17. Cord Prolapse: Cord prolapse is a rare but critical obstetric emergency in which the umbilical cord descends
through the cervix ahead of the baby during labor. This can lead to cord compression, compromising the baby's
oxygen supply and requiring immediate intervention.
18. Deceleration: In fetal heart rate monitoring, deceleration refers to a temporary slowing of the fetal heart rate.
Decelerations can be categorized as early (related to uterine contractions), late (associated with uteroplacental
insufficiency), or variable (occurring unpredictably). They are important indicators of fetal well-being during
labor.
19. Computation of AOG: Computation of Age of Gestation (AOG) is the calculation of the number of weeks
and days that a pregnancy has progressed since the first day of the last menstrual period (LMP). It is crucial for
estimating the due date and monitoring fetal development.
20. Computation of EDC: Computation of Estimated Due Date (EDC) involves determining the expected date
when a pregnancy is likely to reach full term, typically 40 weeks from the first day of the last menstrual period
(LMP). It helps healthcare providers plan prenatal care and monitor fetal growth.
21. Computation for GP TPAL: GP TPAL is an acronym used in obstetrics to summarize a woman's obstetric
history:
- G (Gravida
): Total number of pregnancies, including the current one.

- P (Para): The number of full-term pregnancies (typically defined as pregnancies reaching at least 37 weeks of
gestation) carried to delivery.
- T (Term births): The number of pregnancies reaching full term.
- P (Preterm births): The number of pregnancies delivered before full term.
- A (Abortions): The number of pregnancies that ended before 20 weeks of gestation (spontaneous or induced).
- L (Living children): The number of living children currently.
22. Combined Oral Contraceptives Contraindications: Combined oral contraceptives, which contain both
estrogen and progestin, have specific contraindications, including a history of blood clots, certain medical
conditions like hypertension and migraine with aura, and smoking in individuals over 35 years old. These
contraindications are important to consider when prescribing birth control pills.
23. IUD (Intrauterine Device): An intrauterine device (IUD) is a small, T-shaped contraceptive device that is
inserted into the uterus to prevent pregnancy. It can be either hormonal (releasing progestin) or non-hormonal
(copper-containing), and it offers long-term contraception with high effectiveness.
24. PILLS (Oral Contraceptive Pills): "PILLS" is a colloquial term referring to oral contraceptive pills, which are
birth control medications taken by mouth. They are available in different formulations, including combination
pills (containing both estrogen and progestin) and progestin-only pills (mini-pills).
25. Lactational Amenorrhea Method: The lactational amenorrhea method (LAM) is a natural contraceptive
technique that relies on breastfeeding exclusively, day and night, to suppress ovulation and prevent pregnancy
during the postpartum period. It is most effective when specific criteria are met.
26. Incomplete Abortion: An incomplete abortion is a type of pregnancy loss in which the products of
conception, such as fetal tissue or placental fragments, are partially expelled from the uterus, but some remain
inside. This condition often requires medical or surgical intervention to complete the abortion.
27. Missed Abortion: A missed abortion, also known as a missed miscarriage, is a pregnancy loss in which the
fetus has died, but the body does not expel the pregnancy tissue. This condition is typically diagnosed through
ultrasound and may require medical management or surgical intervention.
28. Methotrexate: Methotrexate is a medication used in obstetrics and gynecology for various purposes,
including the treatment of ectopic pregnancies (pregnancies outside the uterus) and medical abortion in specific
clinical situations. It works by inhibiting cell growth and division.
29. Placental Delivery: Placental delivery is the process that occurs immediately after the birth of the baby,
during which the placenta (afterbirth) is expelled from the uterus. This stage of labor is critical for preventing
postpartum hemorrhage.
30. Signs of Placental Separation: Signs of placental separation include a sudden gush of blood, a lengthening of
the umbilical cord outside the birth canal, and a change in the shape of the uterus as the placenta detaches. These
signs indicate that the placenta is ready for delivery.
31. Mauriceau's Maneuver: Mauriceau's maneuver is an obstetric technique used during the delivery of the baby's
head. It involves applying controlled upward pressure on the fetal head to aid in the safe delivery of the head and
prevent complications during childbirth.
32. Pinard Maneuver: The Pinard maneuver is a method used by healthcare providers to assess the fetal position
and presentation during labor. It involves gentle palpation and assessment of the baby's head and body through
the mother's abdominal wall to determine its orientation in the birth canal.
33. Assessment of Station: Assessment of station in obstetrics refers to determining the level of the fetal head's
descent into the maternal pelvis. It is measured in centimeters above or below the maternal ischial spines, which
helps healthcare providers track the progress of labor.
34. Assessment of Fetal Position: Assessment of fetal position involves determining the orientation of the baby's
head, back, and limbs within the maternal pelvis during labor. This information is crucial for planning the
delivery and managing potential complications.
35. Fetal Position Determination: Fetal position determination is the process of establishing how the baby is
positioned within the mother's pelvis during labor. It includes identifying whether the baby is in the occiput
anterior, occiput posterior, or other positions, which can influence the course of labor.
36. Obstetric Conjugate: The obstetric conjugate is a measurement of the pelvic inlet's smallest diameter, known
as the conjugate diameter. It is crucial for assessing whether the maternal pelvis is adequate for a vaginal delivery
and for estimating the size of the baby's head.
37. Apposition in Implantation: Apposition in implantation is the initial attachment of the blastocyst (early
embryo) to the receptive uterine lining during pregnancy. This process involves the precise interaction between
specific molecules on the embryo and the uterine lining, facilitating implantation.
38. Hydatidiform Mole (HMole): A hydatidiform mole, often referred to as a molar pregnancy, is a rare and
abnormal pregnancy condition characterized by the development of a mass of tissue inside the uterus instead of a
viable embryo. It can be classified as a complete or partial mole and may require medical intervention.
39. Placenta Previa: Placenta previa is a condition in which the placenta partially or completely covers the cervix,
obstructing the baby's passage through the birth canal. This condition can lead to painless vaginal bleeding and
often necessitates a cesarean section delivery to prevent complications.
40. Abruptio Placenta: Abruptio placenta is a serious obstetric complication where the placenta prematurely
detaches from the uterine wall before the baby's birth. This condition can lead to heavy bleeding, abdominal pain,
and fetal distress, posing significant risks to both the mother and the baby.
41. HELLP Syndrome: HELLP syndrome is a severe and potentially life-threatening complication of pregnancy.
The acronym stands for Hemolysis (destruction of red blood cells), Elevated Liver enzymes, and Low Platelet
count. It is often associated with preeclampsia and can lead to multiple organ dysfunction.
42. Rhogam: Rhogam is a brand name for a medication that contains Rh immune globulin. It is given to Rh-
negative pregnant individuals to prevent Rh isoimmunization, a condition in which maternal antibodies attack
fetal red blood cells that have the Rh factor, potentially causing hemolytic disease of the newborn.
43. BMI of 34: A BMI (Body Mass Index) of 34 indicates that an individual's weight is higher than the healthy
range for their height and is classified as obesity. This can have implications for pregnancy, as obesity is
associated with an increased risk of complications.
44. Folic Acid During Pregnancy: Folic acid is a B-vitamin that is essential during pregnancy for preventing
neural tube defects in the developing fetus. It plays a crucial role in early fetal development and is often
recommended as a supplement before and during pregnancy.
45. Non-Stress Test Determination: A non-stress test (NST) is a prenatal test used to assess the well-being
of the fetus by measuring its heart rate in response to its movements. It is typically performed in pregnancies
considered high-risk to monitor fetal health.
46. Contraction Stress Test: A contraction stress test (CST) is a prenatal test used to evaluate the fetus's response
to uterine contractions, typically induced with the use of oxytocin (Pitocin). This test assesses the baby's ability
to tolerate contractions and is often used in high-risk pregnancies.
47. Contraindicated Antibiotics During Pregnancy: Contraindicated antibiotics during pregnancy are antibiotics
that should be avoided due to potential risks to the developing fetus. Examples include tetracyclines and certain
fluoroquinolones, which can affect fetal bone and cartilage development.
48. Galactosemia: Galactosemia is a rare genetic disorder characterized by the body's inability to metabolize
galactose, a sugar found in milk and dairy products. It can lead to serious health issues if not managed through
dietary restrictions.
49. Down Syndrome: Down syndrome is a genetic condition caused by the presence of an extra chromosome 21.
It is associated with intellectual and developmental challenges, as well as various medical conditions. Prenatal
screening and diagnostic tests can assess the risk of Down syndrome during pregnancy.
50. High-Risk Pregnancy: A high-risk pregnancy is one in which specific factors or medical conditions increase
the likelihood of complications for the mother, fetus, or both. These factors can include maternal age, preexisting
medical conditions, multiple pregnancies, or pregnancy-related complications.
51. Birth Plan: A birth plan is a personalized document created by an expectant parent outlining their preferences
and choices for labor, delivery, and postpartum care. It can cover a wide range of topics, including pain
management, birthing positions, and newborn care.
52. Monitoring the Progress of Labor: Monitoring the progress of labor involves continuous assessment of
various factors, including cervical dilation, fetal heart rate patterns, maternal vital signs, and contractions. This
ongoing evaluation helps healthcare providers make informed decisions and ensure the safety of both mother and
baby during childbirth.
53. Third Stage of Labor: The third stage of labor is the final stage of childbirth, beginning immediately after the
birth of the baby and concluding with the delivery of the placenta. During this stage, uterine contractions
continue to expel the placenta from the uterus, and healthcare providers monitor for any signs of complications.
54. Breast Engorgement: Breast engorgement is a condition that occurs when the breasts become swollen, firm,
and painful due to an accumulation of milk. It is a common issue in breastfeeding mothers, typically occurring in
the early postpartum period. Effective breastfeeding techniques and proper breast care can help alleviate this
discomfort.
ENGAGEMENT
- Engagement in obstetrics refers to the descent of the fetal presenting part (usually the head) into the maternal
pelvis. This maneuver is significant as it indicates that the baby's head is in the pelvic inlet, which is a crucial
step in the progress of labor.
ATTITUDE CEPHALIC PROMINENCE

- In obstetrics, the attitude of the fetus refers to the relationship of the fetal body parts to each other. Cephalic
attitude means that the fetal head is flexed onto the chest, which is the ideal position for a vaginal birth. Cephalic
prominence suggests that the baby's head is the presenting part, which is favorable for a safe delivery.
UMBILICAL CORD INSERTED AT THE EDGE OF PLACENTA

- This refers to a condition where the umbilical cord is attached to the placenta near its edge rather than in the
center. While this condition is not typically concerning, it may require monitoring during pregnancy and delivery
to ensure there is no compromise in blood flow to the baby.
ACCRETA: DEEPLY IMPLANTED

- Placenta accreta is a condition in which the placenta attaches too deeply into the uterine wall. This can lead to
complications during childbirth, as the placenta may not detach properly, resulting in bleeding.
SUCCENTURIATA: WITH ACCESSORY LOBE

- Succenturiate placenta is a condition in which the placenta has one or more accessory lobes connected to the
main placental mass by blood vessels. These accessory lobes can increase the risk of postpartum bleeding if they
are not delivered after the main placenta.
CIRCUMVALLATA: CENTRAL DEPRESSION

- Circumvallate placenta is a condition characterized by a thickened, raised ring around the edge of the placenta,
creating a central depression. This condition can sometimes lead to complications during pregnancy, such as
placental abruption.
MCROBERTS MANEUVER: DELIVERY OF SHOULDER IN BREECH PRESENTATION

- The McRoberts maneuver is a technique used during childbirth, particularly in cases of breech presentation
(when the baby is positioned feet or buttocks first). It involves sharply flexing the mother's legs towards her
abdomen, which can help to release the baby's shoulder and facilitate delivery.
MAURICEAUS MANEUVER: DELIVERY OF FETAL HEAD IN BREECH

- The Mauriceau-Smellie-Veit maneuver is used during childbirth when the baby is in a breech position. It
involves the gentle rotation of the baby's head to help facilitate delivery.
OBSTETRIC CONJUGATE: NARROWEST AP DIAMETER OF PELVIS

- The obstetric conjugate is a measurement of the pelvic inlet's narrowest diameter. It is a crucial measurement in
obstetrics, as it helps determine whether a baby can safely pass through the birth canal.
AVOID MILK, AVOID GREASY AND FATTY FOODS, MAGNESIUM AND ALUMINIUM HYDROXIDE,
SMALL FREQUENT FEEDING: HEARTBURN MANAGEMENT
- These recommendations are typically given to individuals experiencing heartburn or acid reflux. Avoiding
triggers like greasy and fatty foods, consuming magnesium and aluminum hydroxide-containing antacids, and
opting for small, frequent meals can help manage symptoms of heartburn.
HBMR, PANEL 2: DANGER SIGN WHAT PANEL

- PANEL 2
CONDYLOMATA ACUMINATA/HPV: CAULIFLOWER-LIKE LESIONS

- Condylomata acuminata, also known as genital warts, is caused by the human papillomavirus (HPV). These
warts appear as raised, cauliflower-like growths on the genital and anal areas.
BACTERIAL VAGINOSIS: PAP SMEAR CLUE CELLS

- Bacterial vaginosis (BV) is a common vaginal infection. When a healthcare provider examines a vaginal
discharge sample under a microscope during a Pap smear, they may observe "clue cells," which are a sign of BV.
CANDIDIASIS/MONILIASIS: FISHY SMELLING. CHEESE-LIKE

- Candidiasis, also known as a yeast infection or moniliasis, can cause symptoms like itching, a fishy odor, and a
cottage cheese-like discharge in the vaginal area.
THREATENED ABORTION: ABORTION. CLOSED CERVIX WITH FHR

- A threatened abortion is a condition in which vaginal bleeding occurs during early pregnancy, but the cervix
remains closed, and fetal heart rate (FHR) is detectable. It is considered a warning sign of a potential miscarriage.
INEVITABLE ABORTION: OPEN CERVIX. NO FHR

- Inevitable abortion refers to a situation in which vaginal bleeding during early pregnancy is accompanied by an
open cervix, and there is no detectable fetal heart rate. It indicates that a miscarriage is likely to occur.
CONTINUE BF AND COMPLETE EMPTYING OF THE BREAST: ENGORGEMENT MANAGEMENT

- Engorgement management in the context of breastfeeding involves continuing to breastfeed (BF) your baby and
ensuring that your breasts are fully emptied to relieve breast engorgement, a common issue when milk
production increases.
KEEP IT CLEAN AND DRY, WATER: DIAPER RASH MANAGEMENT

- Diaper rash management involves keeping the baby's diaper area clean and dry to prevent or alleviate diaper
rash. Using water for gentle cleaning instead of harsh soaps or wipes is recommended.
CATEGORY III: CATEGORY. RISK OUTWEIGHS BENEFITS

- In the context of fetal heart rate monitoring during labor, Category III refers to a classification indicating that
the fetal heart rate pattern shows severe abnormalities, and the risk to the baby may outweigh the potential
benefits of continuing with the current course of action.
PE: PROLIFERATIVE ESTROGEN

- PE is an abbreviation for "proliferative endometrium," which is a phase of the menstrual cycle. During this
phase, estrogen levels rise, causing the endometrial lining to thicken in preparation for possible implantation of a
fertilized egg.
CORTICOSTEROIDS: BETAMETHASONE/DEXAMETHASONE, GIVEN WEEKLY UNTIL TERM:

MATURITY OF LUNGS. LS RATIO 2:1
- Corticosteroids like betamethasone and dexamethasone are administered to pregnant individuals at risk of
preterm birth to accelerate fetal lung development. The LS ratio (lecithin-sphingomyelin ratio) is a test used to
assess lung maturity in the fetus. A ratio of 2:1 or higher is indicative of lung maturity.
BARTHOLOMEW'S: 3 LANDMARKS. 1. SYMPHYSIS 12 WEEKS, 2. UMBILICUS/NAVEL 20 WEEKS, 3.

XYPHOID PROCESS 36 WEEKS
- Bartholomew's rule is a way to estimate fetal growth during pregnancy based on the measurement of the fundal
height (the height of the uterus) in relation to specific landmarks on the mother's abdomen at different stages of
pregnancy.
PARTOGRAPH. RIGHT OF ACTION LINE. WHAT TO DO? REFER. CENTRAL FEATURE IS CERVICAL
DILATATION. PARTOGRAPH. WHEN TO START PLOTTING? ACTIVE 4CM
- A partograph is a tool used to monitor the progress of labor. The "right of action line" is a reference line on the
partograph. If labor progress crosses to the right of this line and cervical dilatation is slow, it may indicate a need
for referral or intervention. The partograph is typically started when the woman is in active labor, usually defined
as cervical dilation of 4 centimeters or more.
LOCHIA. 2 DAYS.? RUBRA, RED

- Lochia is the postpartum vaginal discharge that occurs after childbirth. In the first 2-3 days after delivery,
lochia is typically bright red and referred to as "lochia rubra."
LACERATION. RECTAL? 4TH DEGREE

- Lacerations during childbirth are categorized into degrees based on their severity. A 4th-degree laceration
involves a tear that extends through the vaginal and perineal tissues, through the anal sphincter, and into the
rectal mucosa.
SOURCES OF IRON? LIVER, DARK GREEN LEAFY VEGETABLES

- Iron is an essential nutrient, and dietary sources of iron include foods like liver and dark green leafy vegetables.
These foods are rich in heme iron, which is highly absorbable by the body.
LEOPOLDS. ENGAGEMENT? 3RD MANEUVER
- Leopold's maneuvers are a series of four steps used to assess the position of the fetus within the mother's womb.
The 3rd maneuver involves palpating the upper abdomen to determine whether the fetal head is engaged in the
pelvis.
LEOPOLDS. SIDES OF PELVIS? 2ND

- In Leopold's maneuvers, the 2nd maneuver involves palpating the sides of the mother's abdomen to determine
the position of the fetal back and the location of the fetal heart sounds.
PSEUDOCYESIS? FALSE PREGNANCY. SIGNS/SYMPTOMS: AMENORRHEA, NAUSEA, UTERINE

GROWTH
- Pseudocyesis, also known as false pregnancy or pseudopregnancy, is a condition in which a person experiences
many of the signs and symptoms of pregnancy, including amenorrhea (absence of menstruation), nausea, and
even uterine enlargement, despite not being pregnant.
IRREVERSIBLE: BTL (BILATERAL TUBAL LIGATION), VASECTOMY

- Irreversible methods of contraception include bilateral tubal ligation (BTL) for females and vasectomy for
males. These procedures are intended to be permanent and are difficult to reverse.
LONG-TERM REVERSIBLE: IUD (INTRAUTERINE DEVICE)

- Intrauterine devices (IUDs) are long-term reversible methods of contraception. They can provide contraception
for several years but can be removed when a person wishes to become pregnant.
POSTPARTUM FAMILY PLANNING METHODS: LAM (LACTATIONAL AMENORRHEA METHOD),

IUD, POP (PROGESTIN-ONLY PILL), DEPO (DEPO-PROVERA INJECTION)
- These are various methods of family planning that can be used in the postpartum period to prevent pregnancy.
LAM is based on breastfeeding, while the others involve hormonal or non-hormonal contraceptives.
POSTPARTUM HEMORRHAGE CAUSE? BOGGY UTERINE ATONY

- Postpartum hemorrhage (PPH) is excessive bleeding after childbirth. One common cause is uterine atony,
where the uterus fails to contract properly after delivery, resulting in a "boggy" or soft uterine muscle.
PIH: PREGNANCY-INDUCED HYPERTENSION

- PIH stands for pregnancy-induced hypertension, which is a condition characterized by elevated blood pressure
during pregnancy.
CONVULSION? ECLAMPSIA, GIVE MG SO4 TO PREVENT CONVULSION

- Convulsions can occur in severe cases of preeclampsia or eclampsia during pregnancy. To prevent convulsions
in eclampsia, magnesium sulfate (MgSO4) is often administered.
DARK RED VAGINAL BLEEDING. BOARD-LIKE ABDOMEN. 7 MOS? ABRUPTIO

- Dark red vaginal bleeding and a board-like abdomen can be signs of placental abruption (abruptio placentae), a
serious complication during pregnancy where the placenta detaches from the uterine wall prematurely.
GLUCOSE CHALLENGE TEST. GESTATIONAL DIABETES

- The glucose challenge test is used to screen for gestational diabetes during pregnancy. It involves drinking a
sugary solution, and blood sugar levels are tested to assess how well the body processes glucose.
THICKENING OF ENDOMETRIUM? ESTROGEN

- The thickening of the endometrial lining of the uterus is primarily influenced by estrogen. Estrogen levels rise
during the menstrual cycle, causing the endometrium to thicken in preparation for potential embryo implantation.
MUCUS BECOMES THIN? HORMONE? ESTROGEN

- Thin cervical mucus is often associated with high estrogen levels, particularly during the fertile period of the
menstrual cycle. Thin mucus facilitates the passage of sperm through the cervix.
PRECIPITATE LABOR MANAGEMENT? RAPID BREATHING. DO NOT PUSH

- Precipitate labor, characterized by a very rapid progression of labor, may require rapid breathing techniques and
a warning not to push until healthcare providers are present to assist with delivery.
INVOLUTION? UTERINE CONTRACTION

- Involution is the process by which the uterus returns to its normal, non-pregnant size and position after
childbirth. It is primarily driven by uterine contractions.
ABDOMINAL PAIN FELT DURING POSTPARTUM. AFTERPAINS MORE COMMON IN

MULTIPAROUS WOMEN
- Afterpains are uterine contractions that occur after childbirth. They are often more pronounced and painful in
multiparous women (those who have had multiple pregnancies) due to increased uterine muscle tone.
PROTECTION DURING PREGNANCY. AFTER AT LEAST TT? 2 DOSES OF TETANUS TOXOID (TT)
- Tetanus toxoid (TT) vaccination is recommended during pregnancy to protect both the mother and the newborn
from tetanus. Two doses of TT are typically administered during pregnancy.
LANDMARK IN STATION? ISCHIAL SPINE, NON-PALPABLE

- In obstetrics, the station refers to the position of the fetal head in relation to the maternal pelvis. The ischial
spine is an important landmark, and when the fetal head reaches this level, it is said to be at "zero station." Non-
palpable means that it cannot be felt during a vaginal examination.
MENSTRUATION IS DUE TO
WITHDRAWAL OF PROGESTERONE THAT MAINTAINS THE THICKNESS OF ENDOMETRIUM

- Menstruation occurs when there is a decrease in both estrogen and progesterone levels, leading to the shedding
of the thickened endometrial lining.
FETAL VESSEL. HIGHLY OXYGENATED BLOOD? UMBILICAL VEIN

- The umbilical vein carries highly oxygenated blood from the placenta to the developing fetus.
SECRETORY PHASE (SP): PROGESTERONE

- The secretory phase of the menstrual cycle is characterized by increased progesterone production by the corpus
luteum, which prepares the uterine lining for potential embryo implantation.
OXYTOCIC OR UTEROTONIC DRUGS? OXYTOCIN (DECREASES BP), METHYLERGONOVINE

(INCREASES BP), ENDOTHELIN, PROSTAGLANDIN
- Oxytocic or uterotonic drugs are medications that affect uterine contractions. Oxytocin stimulates uterine
contractions and can decrease blood pressure. Methylergonovine is another uterotonic drug that can increase
blood pressure.
SAGO-LIKE DISCHARGES? HYDATIDIFORM MOLE (COMPLETE MOLE). NEGATIVE FHR. NO

PREGNANCY. ESTROGEN PILLS FOR 1 YEAR. CHORIOCARCINOMA IS PREVENTED BY
METHOTREXATE. GRAPE-LIKE VESICLES
- Sago-like discharges, along with other signs like grape-like vesicles, can be indicative of a hydatidiform mole
(complete mole), a type of gestational trophoblastic disease. Treatment may involve estrogen pills and, in some
cases, chemotherapy with methotrexate to prevent the development of choriocarcinoma.
PID. WHAT CATEGORY OF MEDICAL ELIGIBILITY TO IUD OR CONTRACEPTIVE USE? 4.

CONTRAINDICATION
- Pelvic inflammatory disease (PID) is a contraindication for the use of intrauterine devices (IUDs) and some
other forms of contraception due to the risk of exacerbating the infection.
PURULENT DISCHARGES. STI? GONORRHEA. OFTEN ASYMPTOMATIC IN WOMEN.

TRICHOMONIASIS (TULO)
- Purulent discharges from the genital area can be a sign of sexually transmitted infections (STIs). Gonorrhea is
one such STI that can cause purulent discharge. Trichomoniasis (commonly called "trich") is another STI that
can cause symptoms in women.
2 MOST COMMON CAUSES OF PID? CHLAMYDIA TRACHOMATIS AND GONORRHEA

- Chlamydia trachomatis and Neisseria gonorrhoeae (gonorrhea) are the two most common bacterial infections
that can lead to pelvic inflammatory disease (PID).
JAGGED TEARS? LACERATION

- Jagged tears or wounds with irregular edges are often referred to as lacerations. Lacerations can occur during
childbirth or other traumatic events.
LEOPOLD'S MANEUVER. ATTITUDE? 4TH. CEPHALIC PROMINENCE
- In Leopold's maneuvers, the 4th maneuver assesses the attitude of the fetus. Cephalic prominence indicates that
the fetal head is the presenting part and is favorably positioned for vaginal birth.
BMI OF 40 INTERPRETATION? MORBIDLY OBESE

- A body mass index (BMI) of 40 or higher is classified as morbid obesity. It represents a severe degree of
obesity, which can have significant health implications.
OLIGOHYDRAMNIOS. CAUSE? TRACHEOESOPHAGEAL ATRESIA

- Oligohydramnios is a condition characterized by a decreased amount of amniotic fluid around the fetus.
Tracheoesophageal atresia, a congenital condition where the baby's esophagus is not connected to the stomach,
can lead to oligohydramnios.
VERTEX. AP DIAMETER OF FETAL HEAD? SUBOCCIPITOBREGMATIC

- The suboccipitobregmatic diameter is one of the measurements of the fetal head. It represents the shortest front-
to-back diameter of the fetal head in the vertex (head-first) position.
CAUSE OF CONSTIPATION DURING LABOR? IMMOBILITY

- Constipation during labor can be attributed to the immobility of the mother, as she may be confined to the labor
bed and reluctant to bear down or strain due to pain or discomfort.
OVIDUCTS? FALLOPIAN TUBES

- The oviducts, also known as fallopian tubes, are the structures through which an egg travels from the ovary to
the uterus, and where fertilization typically occurs.
NON-PALPABLE DURING IE? ISCHIAL SPINE

- The ischial spine is an internal pelvic landmark that is typically not palpable during a vaginal examination (IE).
IE DURING BLEEDING. ARE MIDWIVES ALLOWED? NO, MIDWIVES SHOULD NOT PERFORM
VAGINAL EXAMINATIONS DURING BLEEDING OR IF THERE ARE SIGNS OF COMPLICATIONS, AS
IT REQUIRES MEDICAL EVALUATION AND SUPERVISION.
MECONIUM IS NORMAL, AND NO NEED FOR REFERRAL FOR BREECH

- The presence of meconium (the baby's first stool) in the amniotic fluid is generally considered normal.
However, if meconium is passed by the baby in distress or before birth, it may be a concern and require medical
evaluation.
THERE IS FIRM UTERINE CONTRACTION BUT THERE IS STILL BLEEDING. WHAT TO SUSPECT?
LACERATION
- If there is firm uterine contraction but persistent bleeding, a laceration, particularly of the cervix or vaginal
wall, may be suspected as the source of bleeding.
FOOD-BORNE DISEASES? HEPATITIS A

- Hepatitis A is one of the foodborne diseases that can be transmitted through contaminated food or water.
SYPHILIS CAUSATIVE AGENT? TREPONEMA PALLIDUM

- Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum.
POSITIVE FERN TEST IS DUE TO ESTROGEN

- A positive fern test is an indicator of amniotic fluid leakage during pregnancy. It occurs because amniotic fluid,
which contains proteins, can form a characteristic fern-like pattern when it dries on a glass slide. Estrogen levels
may also influence the ferning pattern.
CHARACTERISTIC OF CERVIX DURING PREGNANCY? SOFT, GOODELL'S SIGN

- Goodell's sign is a softening of the cervix that occurs during pregnancy. It is one of the physical changes in the
cervix and vagina that can be observed as early signs of pregnancy.
1ST STAGE OF LABOR IS ALSO KNOWN AS? CERVICAL DILATATION STAGE

- The first stage of labor is often divided into several phases, including the latent phase and the active phase. It is
characterized by the dilation (opening) of the cervix.
PARTOGRAPH. INTERVAL OF ALERT AND ACTION? 4 HOURS
- In a partograph, the interval between the "alert" and "action" lines is typically 4 hours. Progress beyond the
"action" line may indicate a need for intervention or referral.
BANDL'S RING (PATHOLOGIC RETRACTION RING, OBSTRUCTED LABOR, DYSTOCIA)

- Bandl's ring is a constriction or ring-like formation that can occur in the uterus during obstructed labor. It can
lead to dystocia (difficult labor) and may require medical intervention.
ENDOMETRIOSIS. PAIN. INFERTILITY

- Endometriosis is a gynecological condition in which tissue similar to the uterine lining (endometrium) grows
outside the uterus. It can cause pelvic pain and is associated with infertility in some cases.
ECTOPIC. UNILATERAL PAIN THAT RADIATES TO THE SHOULDER. AMPULLA OF OVIDUCTS

MOST COMMON. CULLEN SIGN OR BLUISH ON UMBILICUS. SUDDEN KNIFE-LIKE ABDOMINAL
PAIN. THERAPEUTIC IF UNRUPTURED USING METHOTREXATE, MIFEPRISTONE, OR ANTI-
PROGESTERONE AND MISOPROSTOL (CYTOTEC)
- An ectopic pregnancy is a pregnancy that occurs outside the uterus, most commonly in the fallopian tube
(ampulla). Symptoms can include unilateral pain, referred shoulder pain, and, in some cases, bluish discoloration
of the umbilicus (Cullen sign). Treatment options depend on the condition and may include medications like
methotrexate or surgical intervention.
HYPEREMESIS GRAVIDARUM: EXCESSIVE VOMITING DUE TO ABNORMAL HCG THAT COULD

LEAD TO ELECTROLYTE IMBALANCES. SMALL, FREQUENT FEEDING AND HYDRATION ARE
COMMON MANAGEMENT STRATEGIES.
- Hyperemesis gravidarum is a severe form of morning sickness characterized by excessive vomiting during
pregnancy. It can lead to dehydration and electrolyte imbalances. Management often involves small, frequent
meals and adequate hydration.
PASSAGE OF MEATY PORTION, OPEN CERVIX, CORD PROLAPSE. TRENDELENBURG OR KNEE-

CHEST OR GENUPECTORAL POSITION. DO NOT PUSH THE CORD BACK AND COVER IT WITH
STERILE GAUZE SOAKED WITH STERILE WATER
- If there is a prolapse of the umbilical cord during labor (when the cord slips ahead of the presenting part of the
baby), it is an emergency situation. The Trendelenburg position, knee-chest position, or genupectoral position
may be used to relieve pressure on the cord. Pushing the cord back is not advisable, and it should be covered with
sterile gauze soaked in sterile water to prevent compression.
CLOSED CERVIX. MILD UTERINE CONTRACTION. SLIGHT VAGINAL BLEEDING? THREATENED

ABORTION
- A threatened abortion is a condition in which vaginal bleeding occurs during early pregnancy, the cervix
remains closed, and mild uterine contractions may be present. It suggests a potential risk of miscarriage.
METHERGINE (METHYLERGONOVINE) WHAT ACTION? SUSTAINED UTERINE CONTRACTION

- Methergine (methylergonovine) is a medication used to stimulate sustained uterine contractions and control
postpartum hemorrhage by helping the uterus contract and prevent excessive bleeding.
THICKENING OF ENDOMETRIUM IS DUE TO WHAT HORMONE? ESTROGEN

- The thickening of the endometrial lining of the uterus is primarily stimulated by estrogen, one of the female sex
hormones.
BEFORE OVULATION. ESTROGEN IS HIGH. DURING OVULATION, PROGESTERONE IS HIGH

- During the menstrual cycle, estrogen levels rise before ovulation, contributing to the development of the follicle
and thickening of the endometrial lining. After ovulation, progesterone levels rise in preparation for potential
pregnancy.
CAUSES OF JAUNDICE IN BREASTFEEDING. PREGNANEDIOL

- Jaundice in a breastfeeding infant can occur due to various factors, including increased levels of bilirubin,
which is a breakdown product of hemoglobin. Elevated levels of pregnanediol, a metabolite of progesterone, can
contribute to this type of jaundice.
HEMORRHOIDS. WHAT TO DO? SITZ BATH (38-42°C, 20 MINUTES)

- Hemorrhoids are swollen blood vessels in the rectal and anal area. A sitz bath, where the lower part of the body
is immersed in warm water, can help relieve discomfort and reduce inflammation.
ORTHOPNEIC POSITION. WHAT DEGREE? 60-70 DEGREES. IT ALLOWS A PERSON TO BREATHE

MORE EASILY WHEN EXPERIENCING RESPIRATORY DISTRESS, SUCH AS IN ASTHMA.
POSTERIOR VAGINA? CUL-DE-SAC

- The posterior part of the vagina is often referred to as the cul-de-sac, or the pouch of Douglas. It is located
behind the cervix and uterus.
ANTERIOR VAGINA? URINARY BLADDER

- The anterior part of the vagina is adjacent to the urinary bladder.
HIV. AFFECTED/INFECTED AREA? VULVA

- HIV can affect various parts of the body, including the vulva, which is the external female genitalia.
MUCUS THAT PASSES THROUGH VAGINA? ENDOCERVICAL MUCUS

- Mucus produced by the endocervical glands passes through the cervix and into the vagina.
BIRTH SPACING? YEARS? 3-5 YEARS

- Birth spacing, or the time interval between pregnancies, is often recommended to be at least 3-5 years to allow
for maternal recovery and optimal health for both the mother and the next child.
FETAL HEAD DESCENT. BELOW PELVIC BRIM? 0/5

- The measurement of fetal head descent is assessed in relation to the pelvic brim (the upper edge of the pelvic
inlet). When the fetal head is at the pelvic brim, it is at a station of 0/5.
KEGELS. WHAT MUSCLE? PUBOCOCCYGEUS MUSCLE

- Kegel exercises are designed to strengthen the pubococcygeus muscle, which is part of the pelvic floor
musculature.
ROP (ROTATION, OCCIPUT POSTERIOR POSITION). BACK LABOR

- ROP refers to the fetal position in which the baby's head is facing towards the mother's spine (occiput
posterior). This position can be associated with "back labor," where the woman experiences intense lower back
pain during labor.
PARTOGRAPH. PASSES ALERT LINE. WHAT TO DO? PERFORM ALERT

- When a partograph shows that progress has crossed the alert line, it may indicate a need for action or
intervention. The specific actions to be taken depend on the clinical context and the facility's protocols.
THIRD STAGE NAME? PLACENTAL DELIVERY STAGE

- The third stage of labor is often referred to as the "placental delivery stage," during which the placenta is
delivered after the birth of the baby.
AMTSL (ACTIVE MANAGEMENT OF THE THIRD STAGE OF LABOR). IT INVOLVES

ADMINISTERING OXYTOCIN AFTER THE DELIVERY OF THE BABY, CONTROLLED CORD
TRACTION, AND UTERINE MASSAGE TO PREVENT POSTPARTUM HEMORRHAGE.
- Active Management of the Third Stage of Labor (AMTSL) is a set of interventions to prevent postpartum
hemorrhage. It includes giving oxytocin after the baby's birth, controlled cord traction to aid in the delivery of the
placenta, and uterine massage to ensure the uterus contracts effectively.
MASS AT THE LEFT SIDE. UNILATERAL PAIN? ECTOPIC PREGNANCY

- A mass on the left side with unilateral pain may be indicative of an ectopic pregnancy, especially if the pain is
severe and associated with other symptoms like vaginal bleeding.
HARD UTERUS. PAINFUL. 8 MOS? ABRUPTIO PLACENTAE

- A hard, painful uterus at 8 months of pregnancy may be a sign of abruptio placentae, a serious condition where
the placenta detaches from the uterine wall before delivery.
MAGNESIUM SULFATE (MGSO4) ACTION? PREVENT CONVULSION

- Magnesium sulfate (MgSO4) is often used in obstetrics to prevent convulsions in cases of severe preeclampsia
and eclampsia.
FETAL CIRCULATION. RIGHT ATRIUM TO LEFT ATRIUM? FORAMEN OVALE
- The foramen ovale is a fetal heart structure that allows blood to bypass the fetal lungs by allowing blood to flow
directly from the right atrium to the left atrium.
AMENORRHEA. SIGN OF PREGNANCY? PRESUMPTIVE

- Amenorrhea (absence of menstruation) is considered a presumptive sign of pregnancy, meaning it suggests the
possibility of pregnancy but does not confirm it.
PSEUDOCYESIS? FALSE PREGNANCY

- Pseudocyesis, also known as false pregnancy, is a condition in which a person experiences symptoms that
mimic those of pregnancy, even though they are not actually pregnant.
DEPO (DEPO-PROVERA INJECTION). ADMINISTERED EVERY 3 MONTHS

- The Depo-Provera injection is typically administered every 3 months as a form of contraception.
IUD PREVENTS IMPLANTATION. COPPER IUD (T-COPPER) IS ONE COMMON TYPE, AND THERE
ARE ALSO MODERN HORMONAL IUDS.
- Intrauterine devices (IUDs) can prevent pregnancy by various mechanisms, including preventing implantation
of a fertilized egg. The copper IUD (T-Copper) is a non-hormonal option, while hormonal IUDs release
hormones locally in the uterus.
IUD INSERTED WHEN? DURING MENSTRUATION

- IUD insertion is often recommended during menstruation to ensure that the woman is not pregnant, and the
cervix is more open and receptive to the device.
CALENDAR METHOD. NOTE FOR? SHORTEST CYCLE MINUS 18 DAYS, LONGEST CYCLE MINUS
11 DAYS
- The calendar method is a natural family planning method that involves tracking menstrual cycles to estimate
fertile and non-fertile days. To calculate the fertile window, subtract 18 days from the shortest menstrual cycle
and subtract 11 days from the longest menstrual cycle.
STANDARD DAYS METHOD FERTILE DAYS? APPLICABLE FOR CYCLES OF 26-32 DAYS, WITH
FERTILE DAYS FROM DAY 8 TO DAY 19
- The Standard Days Method is a natural family planning method suitable for women with regular menstrual
cycles lasting 26 to 32 days. In this method, the fertile days are considered to be from day 8 to day 19 of the
menstrual cycle.
POSTPARTUM HEMORRHAGE (PPH). LOSS OF MORE THAN 500CC OF BLOOD UP TO 28 DAYS.

EARLY PPH OCCURS WITHIN 24 HOURS DUE TO CAUSES SUCH AS UTERINE ATONY,
LACERATION, UTERINE RUPTURE, AND INVERSION. LATE PPH OCCURS AFTER 24 HOURS UP TO
28 DAYS DUE TO CAUSES SUCH AS RETAINED PLACENTAL FRAGMENTS AND INFECTION.
- Postpartum hemorrhage (PPH) is defined as the loss of more than 500 milliliters (mL) of blood within 24 hours
after childbirth. Early PPH occurs within the first 24 hours, while late PPH occurs between 24 hours and up to 28
days after childbirth. Various causes can contribute to PPH.
CALKIN'S SIGN. GLOBULAR SHAPE OF ABDOMEN. FIRST SIGN OF PLACENTAL SEPARATION

- Calkin's sign is a clinical sign in obstetrics characterized by a globular or rounded shape of the abdomen. It is
considered the first sign of placental separation or detachment during labor.
COLIC. WHAT TO DO? BURP

- Colic in infants is often associated with excessive crying and fussiness, which can be caused by gas or
discomfort in the gastrointestinal tract. Burping the baby can help alleviate symptoms.
WEIGHT GAIN DURING PREGNANCY. KI
LOGRAMS (KG) AND POUNDS (LBS)? APPROXIMATELY 10-12 KILOGRAMS (ABOUT 22-26
POUNDS) IS A RECOMMENDED WEIGHT GAIN RANGE DURING PREGNANCY FOR WOMEN WITH
A NORMAL BMI.
- The recommended weight gain during pregnancy varies depending on a woman's pre-pregnancy BMI. For
women with a normal BMI, a weight gain of approximately 10-12 kilograms (about 22-26 pounds) is often
recommended.
SIGN WITH CANCER OF ENDOMETRIUM? PAIN

- Pain, particularly pelvic pain, can be a symptom of endometrial cancer. Other symptoms may include abnormal
uterine bleeding.
PILLS PREVENT OVULATION. TETRACYCLINE CAN DECREASE THE EFFICACY OF ORAL

CONTRACEPTIVE PILLS. COMPLICATIONS OF ORAL CONTRACEPTIVES CAN INCLUDE
INCREASED RISK OF BLOOD CLOTTING (THROMBOPHLEBITIS), ESPECIALLY IN WOMEN WHO
SMOKE OR HAVE HEART PROBLEMS.
- Oral contraceptive pills (birth control pills) primarily work by suppressing ovulation. Tetracycline, an
antibiotic, can interfere with the effectiveness of oral contraceptives. Additionally, some complications of oral
contraceptives can include an increased risk of blood clot formation (thrombophlebitis), especially in women
who smoke or have heart problems.
STATION. PELVIC BRIM 0. ENGAGED

- When the fetal presenting part is at the level of the pelvic brim (station 0), it is said to be "engaged," indicating
that it has descended into the maternal pelvis in preparation for birth.
SPINNBARKHEIT (SCHULTZE SIGN). DUE TO ESTROGEN

- Spinnbarkeit, also known as Schultze sign, refers to the increased stretchiness and malleability of cervical
mucus during the fertile phase of the menstrual cycle. This change in cervical mucus is influenced by estrogen
levels.
BBT (BASAL BODY TEMPERATURE). FOR HOW MANY DAYS IS IT ELEVATED DURING THE
FERTILE PHASE? THE ELEVATED TEMPERATURE LASTS UP TO THE 3RD DAY OF ELEVATION
AFTER OVULATION, INDICATING THE END OF THE FERTILE PHASE.
3 TYPES OF ESTROGEN.
- There are three main types of estrogen:
1. Estradiol: The most abundant type of estrogen in non-pregnant individuals.
2. Estriol: Predominant during pregnancy.
3. Estrone: Common during menopause.
HEART SHAPE. PELVIS? ANDROID

- The android pelvis is a type of pelvis that is typically heart-shaped or wider at the upper part, resembling the
male pelvis. It is less favorable for childbirth compared to the gynecoid pelvis, which is rounder and more
suitable for vaginal delivery.
RITGEN'S MANEUVER. HOW? USED TO PREVENT LACERATION

- Ritgen's maneuver is a technique used during childbirth to help prevent perineal lacerations. It involves
applying pressure to the fetal head's chin to allow controlled stretching of the perineum during delivery.
COLPOSCOPY. VISUALIZATION OF THE CERVIX AND VAGINA

- Colposcopy is a medical procedure that involves the visual examination of the cervix and vagina using a
specialized instrument called a colposcope. It is often performed to assess abnormalities or changes in the
cervical tissue.
MOST COMMONLY AFFECTED SITE OF CERVIX IN CERVICAL CANCER? SQUAMO-COLUMNAR

JUNCTION
- The squamo-columnar junction (SCJ) of the cervix is the most commonly affected site in cervical cancer. It is
the area where the squamous epithelium of the ectocervix meets the columnar epithelium of the endocervix.
DIRECT MATERNAL DEATH DUE TO PREGNANCY

- Direct maternal death refers to a death that occurs due to complications directly related to pregnancy and
childbirth, such as severe preeclampsia, eclampsia, hemorrhage, or infection.
PROLONG THE LIFESPAN OF THE CORPUS LUTEUM? WHAT HORMONE? HCG (HUMAN
CHORIONIC GONADOTROPIN)
- Human chorionic gonadotropin (hCG), produced by the developing placenta, helps prolong the lifespan of the
corpus luteum in early pregnancy. The corpus luteum secretes progesterone, which is essential to maintain the
uterine lining for pregnancy until the placenta takes over hormone production.

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WARNING: ONLY REVIEWEES OF THE TOPNOTCHERS REVIEW GROUP ARE PERMITTED TO ACCESS AND USE THIS MATERIAL.

DO NOT PHOTOCOPY. BATCH NO. 2023110506

OB FINAL COACHING NOTES NOVEMBER 2023

2. Oviducts and Pelvic Inflammatory Disease (PID):

4. Crowning and Ritgen's Maneuver:

7. Battledore Insertion of the Umbilical Cord:

10. Circumvallate Placenta:

11. McRoberts Maneuver:

12. Mauriceau's Maneuver:

13. Obstetric Conjugate:

14. Heartburn Management:

15. HBMR and Panel 2:

16. Condylomata Acuminata (HPV):

17. Bacterial Vaginosis and Clue Cells:

18. Candidiasis (Moniliasis):

19. Threatened Abortion:

20. Inevitable Abortion:

21. Breast Engorgement Management:

22. Diaper Rash Management:

23. Medical eligibility criteria for contraceptive use

24. Proliferative Phase (Estrogen):

25. Corticosteroids for Lung Maturity:

26. Lecithin/Sphingomyelin (LS) Ratio:

27. Bartholomew's Rule:

28. Partograph and Cervical Dilatation:

29. Lochia on the Second Day (Lochia Rubra):

30. Laceration and 4th Degree Tears:

31. Sources of Iron (Liver, Dark Green Leafy Vegetables):

32. Leopold's Maneuver and Attitude (4th Maneuver):

33. Pseudocyesis (False Pregnancy):

34. Types of Contraceptives (Irreversible vs. Long-Term Reversible):

35. Postpartum Family Planning Methods (LAM, IUD, POP):

36. Postpartum Hemorrhage Cause (Boggy Uterine Atony):

37. PIH, Eclampsia, and Magnesium Sulfate:

38. Abruptio Placenta:

Glucose Challenge Test (GCT)

40. Estrogen and Thickening of the Endometrium:

41. Estrogen and Thin Cervical Mucus:

42. Precipitate Labor Management:

43. Uterine Involution:

44. After Pains (More Common in Multiparas):

45. Protection during Pregnancy after Tetanus Toxoid (TT):

46. Station and Non-Palpable Ischial Spine:

47. Menstruation and Withdrawal of Progesterone:

48. Umbilical Vein and Highly Oxygenated Blood:

49. Secretory Phase and Progesterone:

50. Oxytocic (Uterotonic) Drugs:

51. Sago-Like Discharges, Choriocarcinoma, and Methotrexate:

52. PID and Contraceptive Use (Category 4):

53. Purulent Discharges and Gonorrhea:

54. Common Causes of PID (Chlamydia Trachomatis and Gonorrhea):

55. Jagged Tears and Laceration:

56. Leopold's Maneuver and Fetal Attitude (4th - Cephalic Prominence):

57. BMI of 40 (Morbidly Obese):

6. Morbid Obesity: BMI of 40 or higher

58. Oligohydramnios and Cause (Kidney Agenesis/Renal Agenesis):

2. Stages of Labor: Labor is typically divided into three main stages:

): Total number of pregnancies, including the current one.

ATTITUDE CEPHALIC PROMINENCE

UMBILICAL CORD INSERTED AT THE EDGE OF PLACENTA

ACCRETA: DEEPLY IMPLANTED

SUCCENTURIATA: WITH ACCESSORY LOBE

CIRCUMVALLATA: CENTRAL DEPRESSION