High Yield SMLE Notes

Endometriosis Severe dysmenorrhea or Uterosacral nodularity; Endometriosis, initial (acceptable); US, gold standard (best); laparoscopy Post-menopausal dyschezia; depo provea injection Post- menopausal dyspareunia; Estrogen cream If took NSAID, but not improved; OCP, want to preserve family; ablation (fulguration) High risk for endometriosis; Family history, DM, Early menarche and late menopause Endometriosis related to; ovarian cancer

Multiple pregnancy Monozygotic twins; Dichorionic and Diamniotic; 1-3 days monochorionic/diamniotic; 4-8 days Monochorionic and monoamniotic ; 8-13 days Vs. Dizygotic twins; Dichorionic and Diamniotic regardless of the sex

PPH Mx; Oxytocin (20units with 500ml D5) Then methylergonovine (contraindicated in HTN) Then carboprost (contraindicated in asthma ) Then misoprostol. ——- PPH with failed manual compression; If unstable; ligation then hysterectomy If stable; During C/S; B-lynch, During Vaginal delivery; Bakri balloon, ——— Bleeding in delivery, ligation of; internal iliac artery

Cause of PPH; if uterus is Boggy; Atony, if uterus is Firm; Retained part of placenta ——- Risk factors of PPH; multi gravid if ≥6 previous deliveries, precipitate labor if less 3 hours, macrosomia if weight more than 4000, prolonged labor if ≥14h in multi, ≥20h in nulli ——— DIC + respiratory symptoms; amniotic fluid embolism Hypovolemic shock VS. PPH; high pulse pressure, assess PPH; visual Maternal death due to PPH; 20% ——— Female with placenta previa had severe hemorrhage. outcome post delivery; Absence of menstrual cycle (Sheehan) Vs. Asherman’s Syndrome: Multiple D&C, basalis layer removed

Confirm preterm labor; cervical dilatation through Pelvic examination 24w-34w; give steroid to prevent RDS 24w-32w; give Mg sulfate to prevent cerebral palsy Tocolysis choice in preterm labor, 32w-34w; Nifedipine, 24w - 32w; Indomethacin. Tocolysis and even steroid are C/I if there is non-reassuring fetal status (variable deceleration) No tocolysis if closed cervix (or even less than 2cm) Tocolytic side effects; Palpitation Most common complication to an image (twins); Preterm

Full term in labor, retraction ring; obstructed labor Degrees of laceration; SMSM; 1;skin, 2;muscle, 3;sphincter, 4;rectal mucous Make 4th degree perianal tear; Restrained legs with forceps Then Unrestrained legs and in chair. Bleeding when closing the caesarean incision; spleen aneurysm Contraindications of ECV; variable deceleration and bicornuate uterus and placenta previa Retroverted uterus location; fundus. Delay in delivery cause; fundal pressure Sparing in epidural anesthesia; Rectum. ——— Epidural CTG finding; prolonged deceleration Vs. Mg sulfate CTG finding; absent variability

IUGR delivery or fetal death with DIC if stable; SVD, if unstable; C/S ——- GDM delivery: 39w; if well controlled, 36w to 39w; if poorly controlled ——- Elective C/S; full term or 39w ——— Pregnant 41 weeks; any problem; induction of labor if healthy; observe Vs. Pregnant 42 weeks; induction of labor ——— Cord prolapse; Bradycardia; C/S Induction of labor with prostaglandin then bradycardia; terbutaline

CTG categories: Category 1; (If FHR 110-160 and moderate variability and acceleration and early deceleration) Management ; regular surveillance Category 3; (If absent variability with recurrent late deceleration Or absent variability with recurrent variable deceleration Or absent variability with bradycardia Or sinusoidal pattern) Management; emergency C/S Category 2; (If not under category 1 and 3) Management; O2 then IVF then stop oxytocin ——- Prolonged latent phase; Nulli; 20 hours, Multi; 14 hours, If less than 20/40 h; wait, Prolonged active phase; Adequate contractions; 4 hours, Inadequate contractions; 6 hours Prolonged second stage; multi; More than 2 hours nulli; More than 3 hours (add 1hr if epidural) Mx; (linstrumental delivery; if station +2 and above, If less than +2 or 3 attempts of instrumental ;C/S Prolonged 3rd stage; Placenta not delivered within 30 minutes; manual removal

When to do C/S in placenta previa; 36-37 week (= preeclampsia without severe features) Placenta abruption delivery; 34w (= preeclampsia with severe features) Abruptio placenta and bleeding stopped; - If 32wks; reclassify her as high risk patient and weekly U/S, - if 33W; admit ———- Most common condition cause DIC; placenta abruption Placenta previa and continuous bleeding; hospitalization Pregnant unbooked presented with vaginal bleeding, no abd pain, fundal height 34; US and admit APH investigation; US, if US showed placenta previa, next step; CTG

Artificial ruptures of membrane then bleeding and fetal bradycardia; vasa previa Indication of IV iron in iron deficiency anemia ; if HG is 10 and placenta previa Stop in uterine contractions; uterine rupture; immediate delivery ————- 32 week with bleeding and contractions and dilation; intrapartum hemorrhage 32 week with bleeding, no contractions or dilation; antepartum hemorrhage ———- Highest risk factor for placenta abruption; HTN then smoking, Highest risk factor for placenta previa; Twins and smoking

Attached deeply; Placenta Accrete: chorionic villi Attach to the myometrium. (Uterine wall); enter uterine cavity during myomectomy Placenta in implanted in the uterine wall; Placenta Increta; chorionic villi Invade into the myometrium. (Uterine muscle) Placenta Percreta: chorionic villi Penetrate though the myometrium, penetrate the serosa

Increase nuchal translucency; congenital cardiac malformation 12w pregnant, blood test; low creatinine Pregnant with high BHCG; Cause depression of TSH,TRH (not elevation) ——— Screen for Asymptomatic bacteruria; 12-16 weeks Indicate chromosomal abnormalities at; 16-18 weeks Detailed anatomy scan; 18-20 weeks GBS swab; 35-37 weeks ———- Physiological changes; -During pregnancy; increase 40-45% of blood volume -During 1st trimester; increase 20-25% of blood volume ———— Pregnant folic acid; 0.4 or 0.8 or 1 mg/3 months If high risk (hx of neural tube defects); 4mg/3 months If k/c of sickle cell anemia; 5 mg till birth

Pregnancy Related Hematological Problems: Antenatal complication associated with Pregnant with sickle cell disease or taking atenolol or smoking; IUGR Antenatal complication associated with sickle cell trait; UTI ———— Rh isoimmunization; maternal antibodies against RBC (maternal autoantibodies in ABO incompatibility) Anti D given at; 28w, 36w, Postpartum if fetus is RH+ve, In any known event causing Fetomaternal hemorrhage (if only spotting; discharge)

Confirm diagnosis of hyperemesis gravidarum; urine ketone Green amniotic fluid, cause; feral distress Fetal hydrops; antikell antibody Asthma exacerbation in pregnancy; spirometry Hyperthyroidism in 15mg carbimazole, still symptomatic; increase to 20mg Pregnant lady has hypothyroidism, how much do you have to increase her dose; 30% ——— Polyhydramnios causes; anencephaly, Duodenal atresia (trisomy 21) Oligohydramnios causes; Renal problem, utero PlacentaI insufficiency ———— Pregnant with wart; cryotherapy, Pregnant with cervical lesion; colposcopy ——- RUQ pain, most common cause; Appendicitis; if late trimester, Acute choly; if earlier