OB/GYN BOX TOP10

🌸 Ob Gyn 🌸   Here I have attached to you some of my summaries for different topics, including: 1- CTG & Labor 2- Approach of PL & PPROM & PROM 3- Hypertensive disorder of pregnancy 4- Bleeding in late pregnancy (Vasa previa, placenta previa, and placenta abruption) 5- Cervical Cancer

☝🏻Beginning of SMLE Notes (OBGYN)

☝🏻Beginning of SMLE Notes ( OBGYN ).

📍هنا اول رسالة بالقناة ( كل القناة مختصرة وتقدر تتصفحها من اول رساله الى آخر رساله ) كل الملفات والنوتات الموجودة هنا بقناة الاوبي مهمه جداً ✅

😂👍فنان والله ⬇️

Physiological Changes in Pregnancy ⬆️Renal plasma flow and GFR in early pregnancy 40-50% ⬆️Stroke volume 10-30% ⬆️Cardiac output 33-45% ⬆️Thyroxine T4 (5 g/dL) ⬇️Creatinine Respiratory🫁: ⬆️Tidal volume ⬇️Residual volume Source: Hacker

Tx of UTI and Asymptomatic Bacteriuria in Pregnancy🤰 1. Fosfomycin 2. Cephalosporin (Cefpodoxime, Cefalxin) 3. Amoxicillin/Clavulanic acid (Augmentin) Potentially appropriate: 1. Nitrofurantoin 2. TMP/SMX ^If both are options choose Nitro C/I🙅‍♀️🤰 1. Fluoroquinolones (Ciprofloxacin) 2. Aminoglycosides (Gentamicin) • Chlamydia In pregnancy-> Azithromycin

Perineal tear: I: Vaginal tear II: Perineal mm. tear III: Anal sphincter tear IV: Rectal tear

Anembryonic Pregnancy US

Pelvic organ prolapse POP • Sx: feeling bulge in vagina, difficulty emptying the bladder • Dx: post voiding residual volume, Speculum examination of the vagina • Tx: - Asymptomatic > Expectant - 1st line is conservative > Vaginal Pessary - Failed conservative > surgical Types: - Anterior vaginal wall prolapse, associated w cystocele or urethrocele - Posterior vaginal wall prolapse, associated w rectocele or enterocele - Uterine prolapse - Vaginal vault prolapse

Urinary Incontinence Stress urinary incontinence: • RF: multipara, pelvic surgery • Sx: w cough, sneeze, laugh • Mechanism: Hypermobile urethra • Tx: - Kegel exercise - Definitive > Midurethral slings (Tension-free vaginal tape or Transobturator tape) Urgency urniary incontinence • Sx: sudden urge to void, frequent voidings, dysuria • Dx: - Urodynamic study: contracting bladder even w small amount of dripping • Tx: - Initial: lifestyle, kegel - Anticholinergic (oxybutynin) DDx: If dysuria, dribbling urine + dyspareunia > Urethral diverticulum

Vaccinations A must preconception vaccination: - MMR (measels, mumps, rubella) Rubella: To reduce stillbirth - Varicella ^If a pregnant lady tested positive for rubella -> Repeat rubella antibody after 2 weeks In pregnancy: - Influenza (regardless of trimester) - Tdap/DTaP (third trimester) Pregnant never had chickenpox, -ve antibodies > Avoid exposure

Contraception OCP • Uses: - Heavy bleeding, nulliparity, healthy - Surgical menopause (total hysterectomy and bilateral oophrectomy) - Ovarian cyst - Dysmenorrhea endometriosis • S/E: - Affected by Azithromycin IUD • Uses: - Heavy bledding w HTN (minera) - CVS disease/PE - Postpartum • C/I: - Genital bleeding Depo provera injection/Progestin only injection • Uses: - Postpartum, wnats long-term contraception (2 y) • S/E: - Dec mineral density Emergency contraceptives • MOA: prevent ovulation

Menstrual Cycle Abnormalities AUB Acute mx: 1. ABC, IV fluid, RBCs transfusion 2. 1st line is IV conjugated estrogen 3. If failed > D&C Chronic mx: - 1st: IUD (progestrone/Minera) or OCP Dysmenorrhea • Sx: painful menses • Types: Primary, secondary • Tx: - 1st: NSAIDs - 2nd: OCP Premenstrual Dysmorphic Disorder (PMDD) • Most common affective sx: Mood swings • Tx: - 1st: SSRI, if she doesn’t wants pregnancy > OCP

Endometrial Ca • RF: - Most significant: unappoused estrogen (e.g. PCOS, obesity) - Infertility, early menarche - Tamoxifen (w/o fibroid) • Dec risk: Progestrone, OCP • Sx: postmenopausal bleeding • Dx: - Staging > Laparoscopy - Confirm > Histology Mx: - Next > Polypectomy - During surgery: Para-aortic LN dissection Endometrial Hyperplasia • Same RF as Endometrial Ca • Sx: Bleeding (mostly menopause) • Dx: - US: inc endometrial thickness (>=0.5 cm) - Confirm > Histology • Mx: - w/o atypia: progesterone (if refuse > observe) - w atypia: Hysterectomy (if wants pregnancy > Progesterone) DDx: Endometrial atrophy > ONLY intermittent vaginal bleeding postmenopause

Uterine Leiomyoma (fibroids) • RF: - inc age, multiparty, obesity, early menarche - Tamoxifen > Leiomyosarcoma • Sx: Submucosal fibroid causes significant bleeding and infertility • On exam: irregularity • Dx: initial and diagnostic: Pelvic US • Mx: 1) Observation - Asymptomatic, no infertility, F/U w yearly US 2) Medical - 1st line is OCP - GNrH is used to shrink fibroid before surgery 3) Surgical Myomecyomy - Hysteroscopic: Submucosal fibroid and symptomatic - Laparoscopic: intramural and subserosal fibroids - Laparotomy: V. Large fibroids Pt doesnt want to concieve > Hysterectomy Pt doesnt want to concieve and wants less invasive > Uterine a emobilization Adenomyosis • RF: Multiparity, age 40-50, Prior uterine surgery (CS, myomecyomy) • Sx: Menorragia, dysmenorrhea, dyspareunia • On exam: globular, boggy, enlarged uterus • Dx: Initial > TVUS Confirmatory > Histopathology • Mx: Symptomatic > OCP Definitive > Hysterectomy

Cervical Ca Screening: • Starts at 21 yo • 21-29: PAP smear every 3 y • 30-65: PAP every 3 y or HPV test +/- PAP every 5 y PAP smear results: 1. Unsatisfactory: repeat after 2-4 mo 2. ASC-US: 21-24: repeat next year > 24: HPV test Persistent results: colposcopy 3. ASC-H: colposcopy 4. LISL 21-24: repeat next year 24-30: Colposcopy >30: HPV test 5. HSIL: Colposcopy Cervical lesion: colposcopy w punch biopsy (colposcopy-directed biopsy) Biopsy results: CIN 2/3: managed by cold knife conization (another option is LEEP)