Quick Notes
DIAGNOSIS: (1) Regular uterine contractions with or without pain (at least one in every 10 minutes); (2) Dilatation (> 2 cm) and effacement (80%) of the cervix; (3) Length of the cervix (measured by TVS) < 2.5 cm and funneling of the internal os and (4)…
Preterm labor is very unlikely when cervical length is >30 mm, irrespective of uterine contractions.
Quick Notes
DEFINITION of Preterm labor (PTL): -It is defined as one where the labor starts before the 37th completed week (<259 days), counting from the first day of the last menstrual period. -The lower limit of gestation is not uniformly defined; whereas in developed…
WHO definition of Preterm Labor (PTL)
-Regular contractions associated with cervical changes ( <37complete ->20 weeks of pregnancy )
-Birth weight < 2500 g
•Threatened PTL: presence of uterine contractions in absence of cervical changes.
•Early PTL: is PTL occurring < 34 weeks gestation.
lt is the more serious type of PTL.
•Late PTL: is PTL occurring > 34 but < 37 weeks.
It carries less foetal risks than early PTL.
#Obs_Gyne
-Regular contractions associated with cervical changes ( <37complete ->20 weeks of pregnancy )
-Birth weight < 2500 g
•Threatened PTL: presence of uterine contractions in absence of cervical changes.
•Early PTL: is PTL occurring < 34 weeks gestation.
lt is the more serious type of PTL.
•Late PTL: is PTL occurring > 34 but < 37 weeks.
It carries less foetal risks than early PTL.
#Obs_Gyne
Remember:
-Screening for GDM is done between 24 and 28 weeks of pregnancy.
-Fetal congenital malformations are high (2 to 6-fold increase) in diabetic woman (pregestational diabetes); most common is cardiovascular.
#Obs_Gyne
-Screening for GDM is done between 24 and 28 weeks of pregnancy.
-Fetal congenital malformations are high (2 to 6-fold increase) in diabetic woman (pregestational diabetes); most common is cardiovascular.
#Obs_Gyne
Remember:
-Fetal anomalies are however not increased in case of GDM, Why?
-This is due to the absence of metabolic disturbance during organogenesis, because GDM occurs later during second or third trimester.
#Obs_Gyne
-Fetal anomalies are however not increased in case of GDM, Why?
-This is due to the absence of metabolic disturbance during organogenesis, because GDM occurs later during second or third trimester.
#Obs_Gyne
-GDM is defined as carbohydrate intolerance of variable severity with onset or first rec ognition during the present pregnancy.
-The entity usually presents late in the second or during the third trimester.
#Obs_Gyne
-The entity usually presents late in the second or during the third trimester.
#Obs_Gyne
Remember:
-Pregnancy is a state of chronic low grade inflammation.
-This is associated with increased circulating levels of C-reactive protein (CRP) and interleukin-6 (IL-6).
-Both these factors enhance insulin resistance.
-The defect lies both in insulin secretion and action.
-The ultimate effect is the hyperglycemia.
-Nearly 50% of women with GDM will become overt diabetes (type-2) over a period of 5 to 20 years.
#Obs_Gyne
-Pregnancy is a state of chronic low grade inflammation.
-This is associated with increased circulating levels of C-reactive protein (CRP) and interleukin-6 (IL-6).
-Both these factors enhance insulin resistance.
-The defect lies both in insulin secretion and action.
-The ultimate effect is the hyperglycemia.
-Nearly 50% of women with GDM will become overt diabetes (type-2) over a period of 5 to 20 years.
#Obs_Gyne
Quick Notes
-GDM is defined as carbohydrate intolerance of variable severity with onset or first rec ognition during the present pregnancy. -The entity usually presents late in the second or during the third trimester. #Obs_Gyne
OVERT DIABETES in Pregnancy:
-A patient with symptoms of diabetes mellitus (polyuria, polydipsia, weight loss) and random plasma glucose level of 200 mg/dL or more is considered overt diabetic.
-The condition may be pre-existing or detected for the first time during present pregnancy.
-According to American Diabetic Association diagnosis is positive if:
(a) The fast ing plasma glucose exceeds 126 mg/dL,
(b) the 2 hours post glucose (75 g) value exceeds 200 mg/dL and
(c) HbA1C ≥ 6.5%.
#Obs_Gyne
-A patient with symptoms of diabetes mellitus (polyuria, polydipsia, weight loss) and random plasma glucose level of 200 mg/dL or more is considered overt diabetic.
-The condition may be pre-existing or detected for the first time during present pregnancy.
-According to American Diabetic Association diagnosis is positive if:
(a) The fast ing plasma glucose exceeds 126 mg/dL,
(b) the 2 hours post glucose (75 g) value exceeds 200 mg/dL and
(c) HbA1C ≥ 6.5%.
#Obs_Gyne
Remember:
-All obstetrics complications can occur in Multiple pregnancy EXCEPT Macrosomia and post-term pregnancy.
#Obs_Gyne
-All obstetrics complications can occur in Multiple pregnancy EXCEPT Macrosomia and post-term pregnancy.
#Obs_Gyne
Exam of 18&19,Obs&Gyne,Writing:
1.Define precocious puberty
2.Causes of precocious puberty
3.Methods of contraception used in lactation
4.Methods in emergency contraception
5.Side effects of combined oral contraceptive
6.Management of Postpartum Hemorrhage.
1.Define precocious puberty
2.Causes of precocious puberty
3.Methods of contraception used in lactation
4.Methods in emergency contraception
5.Side effects of combined oral contraceptive
6.Management of Postpartum Hemorrhage.
Quick Notes
Exam of 18&19,Obs&Gyne,Writing: 1.Define precocious puberty 2.Causes of precocious puberty 3.Methods of contraception used in lactation 4.Methods in emergency contraception 5.Side effects of combined oral contraceptive 6.Management of Postpartum Hemorrhage.
1)Definition
-The term precocious puberty is reserved for girls who exhibit any secondary sex characteristics before the age of 8 (before age 7 in whites)
or
-menstruate before the age of 10.
-Precocious puberty may be:
Isosexual where the features are due to excess production of estrogen.
Heterosexual where features are due to excess production of androgen (from ovarian and adrenal neoplasm).
-Precocious puberty is more common in girls (20 times) than boys.
#Obs_Gyne
-The term precocious puberty is reserved for girls who exhibit any secondary sex characteristics before the age of 8 (before age 7 in whites)
or
-menstruate before the age of 10.
-Precocious puberty may be:
Isosexual where the features are due to excess production of estrogen.
Heterosexual where features are due to excess production of androgen (from ovarian and adrenal neoplasm).
-Precocious puberty is more common in girls (20 times) than boys.
#Obs_Gyne
PROLONGED LABOR DEFINITION:
-The labor is said to be prolonged when the combined duration of the first and second stage is more than the arbitrary time limit of 18 hours.
-The prolongation may be due to protracted cervical dilatation in the first stage and/or inadequate descent of the presenting part during the first or second stage of labor.
-Labor is considered prolonged when the cervical dilatation rate is less than 1 cm/h and descent of the presenting part is < 1 cm/h for a period of minimum 4 hours obser-vation (WHO-1994).
#Obs_Gyne
-The labor is said to be prolonged when the combined duration of the first and second stage is more than the arbitrary time limit of 18 hours.
-The prolongation may be due to protracted cervical dilatation in the first stage and/or inadequate descent of the presenting part during the first or second stage of labor.
-Labor is considered prolonged when the cervical dilatation rate is less than 1 cm/h and descent of the presenting part is < 1 cm/h for a period of minimum 4 hours obser-vation (WHO-1994).
#Obs_Gyne
Remember:
-Prolonged labor is defined when the combined duration of first and second stage of labor is more than 18 hours.
-Prolonged latent phase is defined when the duration is more than 20 hours in a primigravida. Normally, it lasts for 8 hours in a primigravida.
-Latent phase ends when the cervix is 4 cm or more dilated.
#Obs_Gyne
-Prolonged labor is defined when the combined duration of first and second stage of labor is more than 18 hours.
-Prolonged latent phase is defined when the duration is more than 20 hours in a primigravida. Normally, it lasts for 8 hours in a primigravida.
-Latent phase ends when the cervix is 4 cm or more dilated.
#Obs_Gyne
OBSTRUCTED LABOR DEFINITION:
-Obstructed labor is the one where, in spite of good uterine contractions, the progressive descent of the presenting part is arrested due to mechanical obstruction.
-This may result either due to factors in the fetus or in the birth canal or both, so that further progress is almost impossible without assistance.
#Obs_Gyne
-Obstructed labor is the one where, in spite of good uterine contractions, the progressive descent of the presenting part is arrested due to mechanical obstruction.
-This may result either due to factors in the fetus or in the birth canal or both, so that further progress is almost impossible without assistance.
#Obs_Gyne
POSTPARTUM HEMORRHAGE (PPH) DEFINITION:
•Quantitative definition is arbitrary and is related to the amount of blood loss in excess of 500 mL following birth of the baby (WHO). It may be useful for statistical purposes. As the effect of the blood loss is important rather than the amount of blood lost,
•The clinical definition, which is more practical, states, “any amount of bleeding from or into the genital tract following birth of the baby up to the end of the puerper-ium, which adversely affects the general condition of the patient evidenced by rise in pulse rate and falling blood pressure, is called postpartum hemorrhage”. Visual estimation of blood loss is inaccurate.
-Therefore, clinical signs and symptoms should be included in assessment of PPH (RCOG-2016).
-The average blood loss following vaginal delivery, cesarean delivery and cesarean hysterectomy is 500 mL, 1000 mL and 1500 mL respectively.
-Depending upon the amount of blood loss, PPH can be:
♦ Minor (<1L),
♦ Major (>1L) or
♦ Severe (> 2L).
-INCIDENCE: The incidence widely varies mainly because of lack of uniformity in the criteria used in definition.
-The incidence is about 4–6% of all deliveries.
#Obs_Gyne
•Quantitative definition is arbitrary and is related to the amount of blood loss in excess of 500 mL following birth of the baby (WHO). It may be useful for statistical purposes. As the effect of the blood loss is important rather than the amount of blood lost,
•The clinical definition, which is more practical, states, “any amount of bleeding from or into the genital tract following birth of the baby up to the end of the puerper-ium, which adversely affects the general condition of the patient evidenced by rise in pulse rate and falling blood pressure, is called postpartum hemorrhage”. Visual estimation of blood loss is inaccurate.
-Therefore, clinical signs and symptoms should be included in assessment of PPH (RCOG-2016).
-The average blood loss following vaginal delivery, cesarean delivery and cesarean hysterectomy is 500 mL, 1000 mL and 1500 mL respectively.
-Depending upon the amount of blood loss, PPH can be:
♦ Minor (<1L),
♦ Major (>1L) or
♦ Severe (> 2L).
-INCIDENCE: The incidence widely varies mainly because of lack of uniformity in the criteria used in definition.
-The incidence is about 4–6% of all deliveries.
#Obs_Gyne