افضل شيت تمشوا عليه للهستوري وفيه كل ما يحتاجوه الدكاترة ،،، خاصة دكاترة السبعين ✨

#اللجنة_العلمية_للدفعة_السادسة
#Group_C
#Obstetrics

الملف كامل ⬇️

ملازم مرسلة من الدكتورة سهام الحميدي
مستشفى الكويت

#اللجنة_العلمية_للدفعة_السادسة
#Group_C
#Obstetrics

ملزمة Abortion الدكتورة انوار الذفيف
مستشفى الكويت

#اللجنة_العلمية_للدفعة_السادسة
#Group_C
#Obstetrics

#Abortion

Expulsion or interruption of the product of conception before the age of viability (28 wk)

____________

🔸Causes of abortion:

1. Idiopathic (m.c)
2. Chromosomal abnormality
3. Infection ➡️ salmonella, brucella, Chlamydia, malaria, CMV
4. Maternal chronic illness ➡️ HTN, SLE, DM, Antiphospholipid syndrome
5. Endocrine cause
6. Uterine abnormality ➡️ congenital Uterine malformation, CX incompetence, Asherman syndrome
7. Drugs ➡️ PG, anaesthesia, alcohol
8. Multiple pregnancy, polyhydramenous
9. Pregnancy on top of IUCD
10. RH. Isoimmunization
11. Trauma
12. Iatrogenic ➡️ aminocentesis, cordocentosis, IUCS

____________

Notes📝
●Abortion may occur early  before 12 wk (80%)
Or late after 13_24 wk (20%)

●Most Common Cause of abortion in 1st trimester ➡️ Fetal Cause (chromosomal abnormality 50%)

●Most Common Cause of abortion in 2nd trimester ➡️ Maternal Cause (commonest cervical incompetence)

●Miscarriage in DM due to ➡️ abnormal cell devision of fetus

____________

📍Evacuation & curettage: used when the cervical os is open➡️ inevitable, incomplete abortion

📍Dilatation & curettage: used when the cervical os is closed➡️missed, complete abortion

____________

📌CPX of Dilatation & curettage

Asherman syndrome

____________

🔸Most useful investigation in cases of recurrent abortion is the hysterosalpingogram (HSG)

____________

🔹Septic abortion:

1. occur after incomplete abortion 2. occur on top of IUCD
3. occur in a criminal abortion

♦️Complication of septic abortion:

1. Septicemia
2. Peritonitis
3. Jaundice
4. Renal failure
5. Gangrene

🟫Management of septic abortion:

1. admission
2. I.V fluid
3. Aggressive antibiotic (IV)
4. antipyrtic

____________

📌Remember:

●Bleeding then pain ➡️ abortion
●Pain then bleeding ➡️ ectopic pregnancy

____________

▪️Causes of DIC:

1. Pre-eclampsia
2. A.P
3. Missed miscarriage
4. Septic abortion
5. IUFD
6. Amniotic embolism

____________

▫️Cervical incompetence:
Any factor cause weakness of cervix or the isthmus

🟣Causes of cervical incompetence:
1. H/O inflammation of cervix
2. H/O access of diletation
3. Congenital anomaly (weakness)
4. Trauma
5. Polyhydramenous / multiple pregnancy.

The commonest cause of painless 2nd trimester abortion is ➡️ cervical incompetence

____________

🔹Hystro-salpingo gram used to detect:

1. CX incompetence
2. Fibroid
3. Congenital anomaly
4. Asherman syndrome

🔸DX of cervical incompetence:

1. Bulging of membrane through the cervix (during pregnancy)
2. Hegar's dilator (after pregnancy)
3. Investigation
4. Hystro salpingo gram
5. Trans vaginal USS

🔹MX of cervical incompetence:

1. Treat the cause
2. Cervical cerclage at 12_14 wk
3. Cerclage is removed at (38 or 36 wk) of pregnancy

____________

🟤CX of cerclage:

1. Infection
2. Trauma
3. Rupture of membrane

Med Easy 🥼

#اللجنة_العلمية_للدفعة_السادسة
#Group_C
#Obstetrics

#تجميعة Abortion 🧡

#Abortion, done ✔️

#Caesarean_section

Fetal delivery through abdomen & uterus incision.
_____________

📍Lower segment C/S is:

Less bleeding
Less infection
Less paralytic ileus
Less risk of rupture

than upper uterine segment [classical C/S]

_____________

🔲 Indication of C/S:
في الصورة

▪️Indication of classical C/S:

1. Fibroid or fibrosis in lower segment
2. Transverse lie
3. Ovarian & uterine cancer
4. If mother dies
5. Extreme prematurity
6. Previous upper segment

_____________

◻️Pre operative preparation of C/S:

1. Pt concent
2. Blood for [HB, HCT, cross match, blood group]
3. LFT, RFT, viral screen
4. Uterine analysis, catheter
5. ECG
6. NPO, IV fluid, anti-emetics
7. Opioid given after baby out

_____________

♦️CPX of C/S:

1. Pre operative
●Hypotension
●Aspiration pneumonia
●Res depression
●Coma

2. Operative
●Injury of bladder, ureter, bowel
●Injury if artery ➡️ Hge ➡️ shock
●Atony ➡️ Hge

3. Post operative :

Early👇
●Paralytic iliac
●Infection
●UTI
●Endometriosis
●DVT
●PE
●Urine retention

Late👇
●infertility
●Intetial obstruction
●Scar rupture
●Placenta accreta

_____________

♦️Indication of Caesarean Hystrectomy:

1. Fibroid
2. Placenta accreta
3. Rupture uterus

Med Easy ✨

#اللجنة_العلمية_للدفعة_السادسة
#Obstetrics
#Group_C