-The diagnosis of DUB is based with the exclusion of ‘organic lesion ’.
-Currently DUB is defined as a state of abnormal uterine bleeding following anovulation due to dysfunction of hypothalamo-pituitary-ovarian axis (endocrine origin).
-DUB, so defined, is not currently favored as the newer terminology, PALM-COIEN is more consistent and systematic.
#Obs_Gyne
-Currently DUB is defined as a state of abnormal uterine bleeding following anovulation due to dysfunction of hypothalamo-pituitary-ovarian axis (endocrine origin).
-DUB, so defined, is not currently favored as the newer terminology, PALM-COIEN is more consistent and systematic.
#Obs_Gyne
-DUB is a state of abnormal uterine bleeding. the types of DUB are:
A) anovulatory (90%):
(a) Menorrhagia,
(b) Metropathia hemorrhagica;
B) ovulatory (20%):
(a) Polymenorrhea;
(b) Oligomenorrhea;
(c) Functional menorrhagia (irregular shedding and irregular ripening of endometrium).
-Ovulatory type of DUB is usually characterized by:
(a) regular cycle length,
(b) heavy bleeding,
(c) there may be presence of PMS, dysmenorrhea, mastalgia and the biphasic pattern of BBT.
#Obs_Gyne
A) anovulatory (90%):
(a) Menorrhagia,
(b) Metropathia hemorrhagica;
B) ovulatory (20%):
(a) Polymenorrhea;
(b) Oligomenorrhea;
(c) Functional menorrhagia (irregular shedding and irregular ripening of endometrium).
-Ovulatory type of DUB is usually characterized by:
(a) regular cycle length,
(b) heavy bleeding,
(c) there may be presence of PMS, dysmenorrhea, mastalgia and the biphasic pattern of BBT.
#Obs_Gyne
Infertility definition:
-It is defined as the inability to conceive within one or more years of regular unprotected coitus.
-Primary infertility denotes those patients who have never conceived.
-Secondary infertility indicates previous pregnancy but failure to conceive subsequently.
-Fecundability is defined as the probability of achieving a pregnancy within one menstrual cycle. In a healthy young couple, it is 20%.
-Fecundity is the probability of achieving a live birth within a single cycle.
#Obs_Gyne
-It is defined as the inability to conceive within one or more years of regular unprotected coitus.
-Primary infertility denotes those patients who have never conceived.
-Secondary infertility indicates previous pregnancy but failure to conceive subsequently.
-Fecundability is defined as the probability of achieving a pregnancy within one menstrual cycle. In a healthy young couple, it is 20%.
-Fecundity is the probability of achieving a live birth within a single cycle.
#Obs_Gyne
Remember:
-Conception is not possible during pregnancy as the pituitary gonadal axis is suppressed by human chorionic gonadotropin (hCG) and hence, no ovulation.
-During lactation, infertility is said to be relative.
#Obs_Gyne
-Conception is not possible during pregnancy as the pituitary gonadal axis is suppressed by human chorionic gonadotropin (hCG) and hence, no ovulation.
-During lactation, infertility is said to be relative.
#Obs_Gyne
Remember:
-Approximately 74 days are required to complete the process of spermatogenesis.
-Additional 12–20 days are needed for spermatozoa to travel the epididymis.
#Obs_Gyne
-Approximately 74 days are required to complete the process of spermatogenesis.
-Additional 12–20 days are needed for spermatozoa to travel the epididymis.
#Obs_Gyne
Postcoital test (PCT) (Sims-Huhner test):
-Principle: PCT is to assess the quality of cervical mucus and the ability of sperm to survive in it. PCT is rarely done these days.
#Obs_Gyne
-Principle: PCT is to assess the quality of cervical mucus and the ability of sperm to survive in it. PCT is rarely done these days.
#Obs_Gyne
-Adenomyosis is a condition where there is ingrowth of the endometrium, both the glandular and stromal components, directly into the myometrium.
-It may be diffuse or focal. It is also defined as endometriosis interna.
#Obs_Gyne
-It may be diffuse or focal. It is also defined as endometriosis interna.
#Obs_Gyne
Remember:
-Preterm prelabor rupture of membranes is rupture of membranes before 37 weeks and before the onset of labor.
#Obs_Gyne
-Preterm prelabor rupture of membranes is rupture of membranes before 37 weeks and before the onset of labor.
#Obs_Gyne
Remember:
In biophysical profile:
-It includes non stress test, fetal breathing movements, fetal trunk movements, fetal tone and amniotic
fluid volume.
-Interpretation is dependant on gestational age.
-Testing is usually starled at 32- 34 weeks' gestation.
#Obs_Gyne
In biophysical profile:
-It includes non stress test, fetal breathing movements, fetal trunk movements, fetal tone and amniotic
fluid volume.
-Interpretation is dependant on gestational age.
-Testing is usually starled at 32- 34 weeks' gestation.
#Obs_Gyne
Endometriosis Definition:
-It is the presence of functioning endometrium (glands and stroma) in sites other than uterine mucosa.
-It is not a neoplastic condition, although malignant transformation is possible.
-These ectopic endometrial tissues may be found in the myometrium when it is called endometriosis interna or adenomyosis.
-Most commonly, however, these tissues are found at sites other than uterus and are called endometriosis externa or generally referred to as endometriosis.
-Endometriosis is a disease of contrast.
-Although it is a benign but it is locally invasive and disseminates widely.
-Cyclic hormones stimulate growth but continuous hormones suppress it.
#Obs_Gyne
-It is the presence of functioning endometrium (glands and stroma) in sites other than uterine mucosa.
-It is not a neoplastic condition, although malignant transformation is possible.
-These ectopic endometrial tissues may be found in the myometrium when it is called endometriosis interna or adenomyosis.
-Most commonly, however, these tissues are found at sites other than uterus and are called endometriosis externa or generally referred to as endometriosis.
-Endometriosis is a disease of contrast.
-Although it is a benign but it is locally invasive and disseminates widely.
-Cyclic hormones stimulate growth but continuous hormones suppress it.
#Obs_Gyne
Remember:
-Vagina doesn't contain glands.
-Bartholin glands are found in the vulva.
-Skene tubules secrets material which contributes to lubrication of vulva.
#Obs_Gyne
-Vagina doesn't contain glands.
-Bartholin glands are found in the vulva.
-Skene tubules secrets material which contributes to lubrication of vulva.
#Obs_Gyne
Remember:
The most sensitive screening test for gestational DM is
50 grams one hour blood sugar
The only confirmatory test for Gestational DM is :-
3 hours glucose tolerance test OGTT.
#Obs_Gyne
The most sensitive screening test for gestational DM is
50 grams one hour blood sugar
The only confirmatory test for Gestational DM is :-
3 hours glucose tolerance test OGTT.
#Obs_Gyne
Twin-twin transfusion syndrome (TTTS)
-It is a clinic opathological state, exclusively met within monozygotic twins (10–15%), where one twin appears to bleed into the other through some kind of placental vascular anastomosis.
#Obs_Gyne
-It is a clinic opathological state, exclusively met within monozygotic twins (10–15%), where one twin appears to bleed into the other through some kind of placental vascular anastomosis.
#Obs_Gyne
Immediate complications after IUD insertion:
- Cramp-like pain: It is transient but, at times, severe and usually lasts for half to 1 hour. It is relieved by analgesic (ibuprofen) taking before insertion or antispasmodic drugs.
-Syncopal attack: Pain and syncopal attack are more often found in nulliparous or when the device is large enough to distend the uterine cavity.
-Partial or complete perforation: It is due to faulty technique of insertion but liable to be met within lactational period when the uterus remains small and soft.
#Obs_Gyne
- Cramp-like pain: It is transient but, at times, severe and usually lasts for half to 1 hour. It is relieved by analgesic (ibuprofen) taking before insertion or antispasmodic drugs.
-Syncopal attack: Pain and syncopal attack are more often found in nulliparous or when the device is large enough to distend the uterine cavity.
-Partial or complete perforation: It is due to faulty technique of insertion but liable to be met within lactational period when the uterus remains small and soft.
#Obs_Gyne
Definition of GIFT:
-GIFT is an abbreviation for Gamate Intra-Fallopian Transfer which is a procedure of Assisted reproductive technology "ART", in which oocytes and sperms are placed into the fallopian tube. This procedure is applicable in patients who have normal fallopian tubes, as it's indicated in presence of mechanical block to transcervical embryo transfer, hostile cervical mucous, pelvic endometriosis and when IVF fails. Pregnancy rate is about 30٪, ectopic pregnancy occurs in about 5٪ of cases.
#Obs_Gyne
-GIFT is an abbreviation for Gamate Intra-Fallopian Transfer which is a procedure of Assisted reproductive technology "ART", in which oocytes and sperms are placed into the fallopian tube. This procedure is applicable in patients who have normal fallopian tubes, as it's indicated in presence of mechanical block to transcervical embryo transfer, hostile cervical mucous, pelvic endometriosis and when IVF fails. Pregnancy rate is about 30٪, ectopic pregnancy occurs in about 5٪ of cases.
#Obs_Gyne
Chronic subdural hematoma
◼️On CT scanning of the head, new blood appears bright (Hyperdense), this brightness remains for about 3 days, thereafter the collection assume a density similar to brain tissue (Isodense), after 2-3 weeks it becomes hypodense, therefore "new blood" looks bright, "intermediate age blood" looks just like the brain, and "old blood" looks some what like CSF.
◼️Chronic SDH is common in elderly and alcoholics due to brain atrophy and stretching of cortical dural bridging veins which are then prone to rupture and bleed, anticoagulants and antiplatelets also increases risk, in these groups even trivial trauma maybe enough.
◼️A chronic SDH is an old hematoma which has been presents for about 2 to 3 weeks, sometimes new bleeds may occur (acute on chronic) appearing heterogenous on CT scan (see fig, new blood bright and old blood dark).
◼️Unlike the thick acute SDH, the old clot is thinned out, it resembles motor oil in viscosity, and so it can be drained by simple burr holes.
#Medicine
◼️On CT scanning of the head, new blood appears bright (Hyperdense), this brightness remains for about 3 days, thereafter the collection assume a density similar to brain tissue (Isodense), after 2-3 weeks it becomes hypodense, therefore "new blood" looks bright, "intermediate age blood" looks just like the brain, and "old blood" looks some what like CSF.
◼️Chronic SDH is common in elderly and alcoholics due to brain atrophy and stretching of cortical dural bridging veins which are then prone to rupture and bleed, anticoagulants and antiplatelets also increases risk, in these groups even trivial trauma maybe enough.
◼️A chronic SDH is an old hematoma which has been presents for about 2 to 3 weeks, sometimes new bleeds may occur (acute on chronic) appearing heterogenous on CT scan (see fig, new blood bright and old blood dark).
◼️Unlike the thick acute SDH, the old clot is thinned out, it resembles motor oil in viscosity, and so it can be drained by simple burr holes.
#Medicine
Indications of CT scan of the head according to NICE guidelines
◼️CT scan must be done within 1 hour if:
1- GCS is less than 13 at any point.
2- GCS is less than 15 at 2 hours.
3- More than one episode of vomitting.
4- Post-traumatic seizure.
5- Focal neurological deficit.
6- Suspected open, depressed or basilar skull fracture.
◼️CT scan should be done within 8 hours if:
1- Age is more than 65 years.
2- Patient has a coagulopathy, taking anticoagulants or antiplatelets including aspirin.
3- Post-traumatic retrograde amnesia for more than 30 minutes.
4- Dangerous mechanism of injury such as RTA.
#Surgery
◼️CT scan must be done within 1 hour if:
1- GCS is less than 13 at any point.
2- GCS is less than 15 at 2 hours.
3- More than one episode of vomitting.
4- Post-traumatic seizure.
5- Focal neurological deficit.
6- Suspected open, depressed or basilar skull fracture.
◼️CT scan should be done within 8 hours if:
1- Age is more than 65 years.
2- Patient has a coagulopathy, taking anticoagulants or antiplatelets including aspirin.
3- Post-traumatic retrograde amnesia for more than 30 minutes.
4- Dangerous mechanism of injury such as RTA.
#Surgery
Williams Obstetrics 26th Edition.pdf
94.5 MB
Williams Obstetrics 26th Edition.
It's considered as the Bible of Obstetrics.
It's considered as the Bible of Obstetrics.
Remember:
-Fibroids, Endometriosis, Breast cancer, Endometrial hyperplasia, Endometrial cancer, Vulval cancer, Ovarian cancer and PID are associated more with Nulliparity!
-Cervical cancer occurs with multiparity.
#Obs_Gyne
-Fibroids, Endometriosis, Breast cancer, Endometrial hyperplasia, Endometrial cancer, Vulval cancer, Ovarian cancer and PID are associated more with Nulliparity!
-Cervical cancer occurs with multiparity.
#Obs_Gyne
Quick Notes
55 year old man, known case of CKD presented with sudden onset chest pain and palpitation.
This is “Acute myocardial infarction complicated by Ventricular tachycardia”
-The ECG shows a wide complex tachycardia at a rate of ~175 bpm.
-Although the rhythm is irregular, there are findings that suggest ventricular tachycardia (VT); Most notably AV dissociation (P waves are shown with arrows). As you see, there is no relationship between P waves and QRS complexes. Note that VT may be irregular in particular at the beginning.
-STT changes are common findings in any rhythm with wide QRS complexes including VT, However, despite secondary STT changes, there are concordant ST-elevations (ST-elevations in leads with positive QRS complexes) in leads 1, aVL and V6 which suggest acute myocardial infarction (MI). The next ECG is taken after the patient got cardioversion shock and confirms anterolateral MI.
#Medicine
-The ECG shows a wide complex tachycardia at a rate of ~175 bpm.
-Although the rhythm is irregular, there are findings that suggest ventricular tachycardia (VT); Most notably AV dissociation (P waves are shown with arrows). As you see, there is no relationship between P waves and QRS complexes. Note that VT may be irregular in particular at the beginning.
-STT changes are common findings in any rhythm with wide QRS complexes including VT, However, despite secondary STT changes, there are concordant ST-elevations (ST-elevations in leads with positive QRS complexes) in leads 1, aVL and V6 which suggest acute myocardial infarction (MI). The next ECG is taken after the patient got cardioversion shock and confirms anterolateral MI.
#Medicine