Quick Notes
TYPES OF OPERATIONS: -Lower segment -Classical or upper segment. #Obs_Gyne
Classical:
-In this operation, the baby is extracted through an incision made in the upper segment of the uterus.
-Its indications in present day obstetrics are very much limited and the operation is only done under forced circumstances, such as:
•Lower segment approach is difficult:
1) Dense adhe sions due to previous abdominal operation;
2) Severe contracted pelvis (osteomalacic or rachitic) with pendulous abdomen.
•Lower segment approach is risky:
1) Big fibroid on the lower segment blood loss is more and contemplating myomectomy may end in hysterectomy.
2) Carcinoma of cervix
3) Repair of high VVF
4) Complete anterior placenta previa with engorged vessels in the lower segment—risk of hemorrhage.
•Perimortem cesarean section:
It is done to have a live baby (rare):
Perimortem section is an extreme emergency procedure.
#Obs_Gyne
-In this operation, the baby is extracted through an incision made in the upper segment of the uterus.
-Its indications in present day obstetrics are very much limited and the operation is only done under forced circumstances, such as:
•Lower segment approach is difficult:
1) Dense adhe sions due to previous abdominal operation;
2) Severe contracted pelvis (osteomalacic or rachitic) with pendulous abdomen.
•Lower segment approach is risky:
1) Big fibroid on the lower segment blood loss is more and contemplating myomectomy may end in hysterectomy.
2) Carcinoma of cervix
3) Repair of high VVF
4) Complete anterior placenta previa with engorged vessels in the lower segment—risk of hemorrhage.
•Perimortem cesarean section:
It is done to have a live baby (rare):
Perimortem section is an extreme emergency procedure.
#Obs_Gyne
Anticoagulation during pregnancy:
• In mechanical valve prosthesis:
- First trimester: warfarin if daily dose is 5 mg or less, or unfractionated heparin (IV) or LMWH (anti-factor 10 adjusted).
- Second and early third trimesters: warfarin (whatever the dose achieving target INR)
- From week 37 till term: UFH (IV).
• In AF or in venous thromboembolism:
- First trimester: warfarin (if daily dose is 5 mg or less), UFH (IV or SC), or LMWH (weight-based).
- Second and early third trimesters: warfarin (whatever the dose achieving target INR), UFH (SC), or LMWH (weight-adjusted).
- From week 37 till term: UFH (IV).
#Obs_Gyne
• In mechanical valve prosthesis:
- First trimester: warfarin if daily dose is 5 mg or less, or unfractionated heparin (IV) or LMWH (anti-factor 10 adjusted).
- Second and early third trimesters: warfarin (whatever the dose achieving target INR)
- From week 37 till term: UFH (IV).
• In AF or in venous thromboembolism:
- First trimester: warfarin (if daily dose is 5 mg or less), UFH (IV or SC), or LMWH (weight-based).
- Second and early third trimesters: warfarin (whatever the dose achieving target INR), UFH (SC), or LMWH (weight-adjusted).
- From week 37 till term: UFH (IV).
#Obs_Gyne
Quick Notes
Anticoagulation during pregnancy: • In mechanical valve prosthesis: - First trimester: warfarin if daily dose is 5 mg or less, or unfractionated heparin (IV) or LMWH (anti-factor 10 adjusted). - Second and early third trimesters: warfarin (whatever the…
This is according the American college of chest physicians "ACCP"!!
BIOPHYSICAL:
Principle—Biophysical profile is a screening test for uteroplacental insufficiency.
-The fetal biophysical activities are initiated, modulated and regulated through fetal nervous system.
-The fetal CNS is very much sensitive to diminished oxygenation. Hypoxia → metabolic acidosis → CNS depression → changes in fetal biophysical activity.
#Obs_Gyne
Principle—Biophysical profile is a screening test for uteroplacental insufficiency.
-The fetal biophysical activities are initiated, modulated and regulated through fetal nervous system.
-The fetal CNS is very much sensitive to diminished oxygenation. Hypoxia → metabolic acidosis → CNS depression → changes in fetal biophysical activity.
#Obs_Gyne
Nuchal translucency:
NT is the fluid-filled space (detected by USG) between the fetal skin and the underlying soft tissue at the region of the fetal neck. NT ≥ 3 mm is abnormal.
#Obs_Gyne
NT is the fluid-filled space (detected by USG) between the fetal skin and the underlying soft tissue at the region of the fetal neck. NT ≥ 3 mm is abnormal.
#Obs_Gyne
Remember:
-Oral contraceptives’ link to an ↑ in breast cancer is not proven.
-Oral contraceptives’ link to an ↑ in breast cancer is not proven.
Quick Notes
BIOPHYSICAL: Principle—Biophysical profile is a screening test for uteroplacental insufficiency. -The fetal biophysical activities are initiated, modulated and regulated through fetal nervous system. -The fetal CNS is very much sensitive to diminished…
The following biophysical tests are used:
-Fetal movement count
-Ultrasonography
-Cardiotocography
-Nonstress test (NST)
-Fetal biophysical profile (BPP)
-Doppler ultrasound
-Vibroacoustic stimulation test
-Contraction stress test (CST)
-Amniotic fluid volume.
#Obs_Gyne
-Fetal movement count
-Ultrasonography
-Cardiotocography
-Nonstress test (NST)
-Fetal biophysical profile (BPP)
-Doppler ultrasound
-Vibroacoustic stimulation test
-Contraction stress test (CST)
-Amniotic fluid volume.
#Obs_Gyne
Types of Hysterectomy:
Abdominal and Vaginal
1-Abdominal
-Total hysterectomy (body& cervix are removed).
-Subtotal hysterectomy (body is removed and cervix is preserved) as in PPH and severe adhesions around the cervix
- Extended hysterectomy(TAH + removal for upper vagina + medial part cardinal ligament. It is for treatment of microinvasive cervical CA (IA2)
-Pan hvsterectomv (TAH + BSO).
-Radical hysterectomy (Wertheim' s operation), it's removal of
TAH and BSO
The whole parametrium (broad ligament)
Pelvic ligaments & LN .
-Extended radical hysterectomy (removal of periurethral tissue & up to 3/4+ ofthe vagina.
-Ultra radical hysterectomy (exentration → anterior, posterior or total).
In obstetrics:
-Supra-vaginal hysterectomy
-Caesarean hysterectomy
-Hysterectomy en toto:
Cervix infection
Cervical cancer is first trimester.
2-Vaginal hysterectomy:
-In Uterine prolapse or inversion
-Any patient with uterine size less than 12 week pregnancy as DUB, small fibroids, adenomyosis.
#Obs_Gyne
Abdominal and Vaginal
1-Abdominal
-Total hysterectomy (body& cervix are removed).
-Subtotal hysterectomy (body is removed and cervix is preserved) as in PPH and severe adhesions around the cervix
- Extended hysterectomy(TAH + removal for upper vagina + medial part cardinal ligament. It is for treatment of microinvasive cervical CA (IA2)
-Pan hvsterectomv (TAH + BSO).
-Radical hysterectomy (Wertheim' s operation), it's removal of
TAH and BSO
The whole parametrium (broad ligament)
Pelvic ligaments & LN .
-Extended radical hysterectomy (removal of periurethral tissue & up to 3/4+ ofthe vagina.
-Ultra radical hysterectomy (exentration → anterior, posterior or total).
In obstetrics:
-Supra-vaginal hysterectomy
-Caesarean hysterectomy
-Hysterectomy en toto:
Cervix infection
Cervical cancer is first trimester.
2-Vaginal hysterectomy:
-In Uterine prolapse or inversion
-Any patient with uterine size less than 12 week pregnancy as DUB, small fibroids, adenomyosis.
#Obs_Gyne
Weight gain during pregnancy:
Normal during whole pregnancy is 11-15 kg.
During first month: No weight gain
During second month: Decrease about half to one kg due to nausea, vomiting and loss of appetite.
During third month: Weight is like that of pre-pregnancy weight.
Remaining 6 months, weight gain is by rate of 2kg/month or 1/2 kg per week.
Excessive weight gain occurs as in Hydrominos, multiple pregnancy, diabetic mother.
Sudden weight gain occurs is Preeclampsia.
#Obs_Gyne
Normal during whole pregnancy is 11-15 kg.
During first month: No weight gain
During second month: Decrease about half to one kg due to nausea, vomiting and loss of appetite.
During third month: Weight is like that of pre-pregnancy weight.
Remaining 6 months, weight gain is by rate of 2kg/month or 1/2 kg per week.
Excessive weight gain occurs as in Hydrominos, multiple pregnancy, diabetic mother.
Sudden weight gain occurs is Preeclampsia.
#Obs_Gyne