OB/GYN BOX TOP10

Vaginal Infections Bacterial vaginosis • Fishy odor🐟 • Clue cells, granulated epithelial cells • Tx: Metronidazole Trichomoniasis • Green discharge, strawberry cervix🍓, itchy • Falgellated protozoa • Tx: Metronidazole + treat sexual partner👫 • DDx: if friable cervix, strawberry, bleeding > Cervicitis (Chlamydia or Gonorrhea) Vaginal yeast/Candidiasis • White cottage cheese🧀 • Pseudohyphae, spores • RF: DM • Tx: Topical azole/nystatin or oral fluconazole Pelvic Infalmmatory Disease PID • Inf of upper GU tract (most common is salpingitis) • RF: IUD (Actinomyces israelii), multiple sexual partners • Sx: discharge, fever, dysparunea, abd pain, cervical motion tenderness • Tx: Gonorrhea > Ceftriaxone Chlamydia > Doxycycline Abcess > IV Abx If -ve culture (not gono or chlam) > could be: - Trichom. > Metro. - HSV > Acyclovir • We do endocervical swab to screen gonorh. • Chlamydia causes adhesions DDx: Atrophic vaginitis • Postmenopausal, itchy Acute simple cystitis in honeymoon • Tx: Nitrophyrantoin Cervicitis: Doesn’t cause abdominal/pelvic pain

Endometriosis • Sx: dyspareunia, dysmenorrhea, dyschezia, infertility, chronic pelvic pain • On exam: fixed/retroverted uterus, nodularity • Dx: - Initial: US (hypoechoic mass, ground glass) - Confirmatory: laparoscopy • Mx: Medical 1) OCP. 2) IUD Postmenopause: progrstrone only Surgical - Conservative > laparoscopic ablation - Definitive > Bilateral oophrectomy Endometriosis inccreases the risk of epithelial ovarian ca

Abortions • <20 w • Types: Complete: close OS, empty uterus, passed tissue Incomplete: open OS, tissue in cervix, bleeding Threatened: closed OS, bleeding, cardiac activity Inevitable: open OS, visible products, bleeding Missed: closed OS, no passing tissue, no bleeding, no cardiac activity Mx: Complete: FU Missed: expectant Incomplete/Threatened/Inevitable: - <=13 w: expectant up to 8 w - Medical: Misoprostol - Hemodynamic instable/bleeding: D&C (evacuation & curettage) Incomplete > Evacuation & Curettage Pregnancy of unknow origin - No extra/intrauterine sac > repeat US DDx: Anembryonic Pregnancy • Sx: brownish vaginal discharge, +/- sx of pregnancy loss • Mx: plan for termination of pregnancy Twin Pregnancy Time of cleavage: - Dichorionic diamniotic: within first 3 days after conception - Monochorionic diamnitotic: Day 4-7 - Monochorionic monoamniotic: D 8-11 - Mono-mono (conjoint): from Day 12

Gestational Trophoblastic Disease GTD • Abn. placental cells • Types: Benign hydatiform mole • Partial or complete (complete has v. high hCG, larger uterus, more sx) • Sx: hyperemsis gravidarum, passing vesicles • Dx: - hCG >100,000 - Next: US: snowstorm (complete mole) - Confirmatory: Histo by suction & curettage • Mx: Suction & curettage • F/U post tx: - hCG: within 48 h, weekly for 3 w, monthly for 6 mo Dec: <10% in 3 w Plateu: within +/-10% in 2 w Inc: >10% in 3 w - If plateu/increasing > refer to gynecology Gestational trophoblastic neoplasia (GTN) • Most imp type is Choriocarcinoma • Presents w metastasis: 1) Pulmonary 80%: hemoptysis 2) Vagina 30%: fragile mass easily bleeds • Dx: Staging (xray) • Mx: chemo

Ectopic pregnancy • Sx: Abd. pain, missed period, bleeding • Acute sudden pain, hemodynamic instability > Tubal rupture • RF: PID • Dx: first is hCG then US • Mx: Medical: Methotrexate - Stable - Initial hCG <=5000 - Mass <=4 cm - No cardiac activity - Patient can comply - C/I: rupture, instable, inability to comply Failure of mefical tx (failure of hCG to decrease by 15% in 4-7 d): - Additional dose - Failed: surgery (laparoscopic) Surgical - Ruptured (lap.) - Salpingectomy is the standard, needs only one hCG F/U - Salpingostomy if pt wants to concieve, needs weekly hCG F/U - Laparotomy is only in hemodynamic instability - Remnants after surgery: additional dose of MTX - Pt w severe pain > Exploratory laparoscopy

APH • Bleeding in > 20 w • First step is US to exclude placenta previa • Causes: Abruptio placenta • RF: HTN, Smoking, PROM, Polyhydro, Trauma • Sx: Pain, tenderness, fetal distress, +/- bleeding • Mx: - Unstable mother/baby > CS - < 34 w: Admission, corticosteroids, MgSO4 (<32) - 34-36: Contracting > Deliver Non-contracting > Expectant - > 36: Deliver Placenta previa • RF: Multiparty, CS, Twins • Sx: painless, bleeding • Tx: Delivery in: - Mother/fetal distress - Bleeding+CAT3 - In labor - Significant bleeding >=34 w Vasa previa • Sx: painless bleeding due to membrane rupture Utrine rupture • RF: overdose of oxytocin/prostaglandin, surgery to myometrium • Sx: pain, tenderness, sudden pause in cx, bleeding, fetal distress (brady.) • Tx: Laparotomy and CS

PPH • SVD: 500 or 1000 ml blood loss • CS: 1000 ml blood loss • Mx: First thing is to start at uterus, call for help, ABC • Primary PPH causes T4 (within 24 h): 1) Uterine atony (70-80%): • Sx: Soft, boggy, poorly contracted uterus • Mx: - Medical mx: 1. Oxytocin (10-40 u) 2. Methylergnovine (C/I in HTN/high BP) 3. Carboprost (Prostaglandin) (C/I in asthma) 4. Misoprostol - Surgical mx: SVD: 1. Bakri ballon 2. Stable: uterine a. embolization Unstable: uterine a. ligation 3. Hysterectomy CS: 1. B-Lynch 2. Stable: uterine a. embolization Unstable: uterine a. ligation 3. Hysterectomy 2) Uterine laceration • Tx: suture 3) Thromboin (coagulation defect): • Amniotic fluid embolism: DIC + SOB + Hemodynamic compromise 4) Retained placenta Best indicator of PPH cx > Maternal pulse rate Causes of secondary PPH (24 h-12 w): Retained products of placenta • Sx: heavy bleeding • Tx: D&C Endometritis • Sx: Pain, tenderness, Fever • RF: CS • Tx: Admission, IV Abx Cx of severe PPH: Sheehan syndrome (necrosis of pituitary gland)

Pregestational DM • HbA1c Goal: <6.5% • Mx: - Give aspirin satrating at 12 w - Folic acid: 800 microgram or 1 mg • Tx: 1. Diet & exercise 2. Insulin (no role for oral meds) • Cx: - Macrosomia (1st most common) - Preeclampsia (2nd most common) - Congenital anomalies (in 1st trimester) - Neonatal RDS GDM • Start screening at 24-28 w • Screening methods: - Two-step approach: 1. 50g OGTT 2. 100g OGTT (needs at least 2 abn readings) - One step approach (75g OGTT): needs one reading • Mx,Tx,Cx as above • Pathophysiology: mediated by lactogen

Chronic Hypertension in Pregnancy • >=140/90 in < 20 w • Tx: - First line: labetolol (if not present in the options, choose Methyldopa) • If the pt takes meds already > Stop it and start tx only in severe HTN Gestational HTN • >=140/90 in > 20 w, w/o proteinuria • Tx: - First line: labetolol (if not present in the options, choose Methyldopa) Preeclampsia • >=140/90 in > 20 w +proteinuria or +end organ damage • RF: DM, Multiple gestation • Tx: - IOL at >37 w 1st: Oral Labetalol 2nd: Oral Nifedipine 3rd: Oral Hydralzine - Dec risk of preeclampsia: Aspirin • Cx: IUGR, oligohyd. Preeclampsia w severe features • Preeclampsia + End organ damage: >=160/110, Hepatic abn, low plt (<100,000), Renal abn, pulmonary edema, CNS sx • Tx: - MgSO4 is always 1st - Antihypertensive: 1st IV labetalol 2nd IV Hydralazine 3rd IV nifedipine < 34: Admission, corticosteroids, MgSO4, IV labetalol >=34: Stabilize then delivery HELLP • Hemolysis, Elevated Liver enzymes, Low Platelets • Tx: IOL Eclampsia: • Tx: 1. ABC 2. MgSO4 3. IOL Goal of Antihypertensives > dec mother morbidity and mortality🪦

Preterm labor Labor (contractions + cervical dilation) at <37 w Mx: • Steroids (<34) • Tocolytics: <32: Indomethacin, 32-34: Nefidepine • >34: Delivery • MgSO4 (< 32) ^Indomethacin can cause PDA🫀⚠️ PPROM ROM w/o contractions at <37 w Mx: • Abx (Ampicillin + Erythromycin) (<34) • Steroids (<34) • MgSO4 (< 32) • Prompt delivery: inf, abruptio placenta, nonreassuring fetus, cord prolapse PROM ROM w/o contractions at term Investigation: Speculum Mx: • IOL • GBS prophylaxis if >=18 h or fever Cervical incomptence • Dx: <24 w, <2.5 cm cervical length Indications for cervical cerclage: • Hx-indicated: done at 13-14 w • US-indicated: <2.5 cm + positive hx • <2.5 cm w/o hx: progestrone • +hx: US close follow-up 14-24 w • Screening at 20 w

CTG and Labor CTG categories: CAT 1: • FHR: 110-160 • +/- Acceleration • +/- Early deceleration Management: Routine surveillance CAT 2: • Not included in CAT 1/CAT 3 Management: In utero resuscitation: 1. Lateral position 2. O2 3. IV fluids 4. Stop oxytocin 5. Give tocolytics (e.g. subcut terubtaline) 6. Surveillance CAT 3: • Absent variability (<3) with recurrent late deceleration • Absent variability (<3) with recurrent variable deceleration • Absent variability (<3) with bradycardia • Sinusodal pattern for at least 20 min Management: In utero resus, prepare for delivery, CS Labor: Stage 1: 0-10 cm Latent phase: < 6 cm, 14-20 h Mx: • SROM > IOL • no SORM > Nothing up to 24 h Active phase: >=6 cm Prolonged active phase: >=6 cm + no cervical changes: • after 6 h of inadequate contractions • OR after 4 h of adequate contractions • Mx: Oxytocin, amniotomy Arrested active phase: >=6 cm + ruptured membranes + no cervical changes: • After 6 h of inadequate contractions despite oxytocin • After 4 h of adequate cobtractions • Mx: CS Bishop score <=6 is unfavorable cervix > Cervical ripening Deceleration types: - Early: head compression - Late: uteroplacental insufficiency - Variable: umbilical cord compression Orientation in utero Fetal lie: Longitudinal, Transverse, Oblique Fetal presentation: • Cephalic • Breech (Frank, Complete, Incomplete) • Compound (e.g. presenting extremity) • Shoulder Fetal attitude: • Vertex presentation (maximum head flexion, most common) • Forehead presentation (partially flexed) • Brow presentation (partially extended) • Face presentation (Maximally extended): Mantum ant > SVD Mantum post > CS Medications effects on FHR: MgSO4: Reduced variability Epidural analgesia: maternal hypotension > uteroplacental insufficiency > late or prolonged deceleration Oxytocin: uterine hyperstimulation > late or prolonged deceleration Pregnant at 41 w and everything is normal > Induction of labor

🔴SMLE Notes⬇️

🔹🔥 OBGYN Course By WAFA 2022 🔥🔹 🔸 العام الماضي 2022 قدمت د.وفاء دورة "مجانية" لعدد من المواضيع الموجودة في مذكرتها ( شرحت تقريبا ٦ مواضيع بعد عمل تصويت في قناتها ) 🔹 تسجيلات الدورة كانت متاحة لكن للجميع لكن الروابط اختفت من الموقع 🔹🔹🔸🔹🔹🔸🔹🔹🔸🔹🔹 🔺 Day 1 : - https://youtu.be/JXA_pp3FZSA 🔺 Day 2 : - https://youtu.be/LLjC2qVjqLg 🔹🔹🔸🔹🔹🔸🔹🔹🔸🔹🔹 التسجيلات لا تغني عن المذكرة .. مثل ما ذكرنا سابقًا انها اختارت عدد من المواضيع فقط و لم تشرح جميع مواضيع المذكرة قناة د.وفاء : WAFA OBGYN - https://t.me/WafaOBGYN

I am preparing for smle as specialist obgy Answer: That’s different level SMLE For general practitioners Specialist high level Be careful, Ask any resident or any specialist .

2024