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

Indication of C/S
مهممه👆

#Caesarean_section ,done ✔️

#pre_term_labour

Labour before completed 37wk

_

🟣Maternal cause of pre term labour:

1. HTN, DM, H.F, anemia
2. Young age <17yrs
3. Familial cause
4. Smoking, alcohol
5. Fibroid, ovarian cyst
6. UTI, vaginitis
7. Uterine anomalies, Cervical incompetence
8. 2nd trimester bleeding
9. Any CPX of placenta (A.P/P.P)
10. Surgery during pregnancy

_

🟣Fetal cause of pre term labour:

1. A.P/ P.P/ pre eclampsia
2. PROM, polyhydramenous
3. Chorioamnionitis
4. Congenital malformation
5. Chromosomal defect
6. Multiple pregnancy
7. RH isoimmunization
8. Macrosomia

_

▪️Types of pre term labour:

1. Threatened labour
2. Inevitable labour
_____

🔹Threatened labour ➡️ CX diletation >2cm [latent phase]

Management:

1. Hospitalization
2. Bed rest
3. Hydration
4. Tocolytics

🔺STOP management in case 👇

1. Chorioamnionitis
2. Fetal distress
3. Congenital malformation
4. Abortion [IUFD]

_____

🔹Invitable labour ➡️ CX dilated 4cm [active phase]

Management:

1. Neonatolgist
2. Episiotomy
3. Forceps, NOT vacuum

📍Prediction of pre term labour by TV USS
If CX length <2.5 cm ➡️ pre term labour

_____

🔴CPX of pre term labour:

1. Intra cranial Hge
2. Respiratory distress syndrome
3. Hypothermia
4. Liqour or meconium Aspiration
5. Anemia
6. Gastroenteritis
7. Mantal retardation
8. Poor suckling
9. Patent ductus arteriosus

_____

🔵Management of Preterm Baby:

1. Suction ➡️ Clear airway.

2. Oxygen therapy ➡️ Support breathing.

3. Surfactant ➡️ Treat RDS.

4. Incubator ➡️ Maintain temperature and humidity.

5. IV glucose ➡️ Prevent hypoglycemia.

6. Early breastfeeding ➡️Early nutrition and immunity.

7. IM Vitamin K ➡️ Prevent bleeding.

_____________

📍Common Corticosteroids used:

1. Betamethasone: 12mg, IM/24 hrs ➡️ 2days

2. Dexamethasone: 6mg, IM/12 hrs➡️ 4 doses

📍Indication of Corticosteroids:

1. Risk of pre term labour
2. Preterm pre mature rupture of membrane
3. Multiple gestations
4. Pre eclampsia, placental insufficiency
5. Planned preterm C/S

#اللجنة_العلمية_للدفعة_السادسة
#Obstetrics
#Group_C

#pre_term_labour , done ✔️

ملزمة فخمة جداً لموضوع الـCTG.

د. إشراق الدبعي
قروب_C4_م.الكويت

#اللجنة_العلمية_للدفعة_السادسة
#Obstetrics
#Group_C4

ملف لل Instrument in Obstetrics

الملف مرسل من الدكتورة رقية الشهاري.

هذه هي الادوات الي بتنسألوا عليهن خاصةً الي عيختبروا في مستشفى السبعين شوفوهن واقرؤوا عليهن 👍

#اللجنة_العلمية_للدفعة_السادسة
#Obstetrics
#Group_C

#Labour

Normal labour is the spontaneous delivery of a single, term, viable fetus in cephalic-vertex presentation with longitudinal lie, through the vagina, without maternal or fetal complications, & within 12–18 hours.

〰〰〰〰〰

🟢Lie:
Relation B/W fetal long axis to maternal long axis

●Longitudinal lie ➡️ Both axis are parallel.
●Transverse lie ➡️ Both axis are perpendicular
●Oblique lie ➡️ Both axis crossing 45°

〰〰〰〰〰

🟢Fetal attitude:
Relation of fetal part to each other
■flexed attitude
■extended attitude.

〰〰〰〰〰

🟢Presenting part:
lowrest part of fetus meet the maternal pelvic

〰〰〰〰〰

🟠Fetal position:

Relation B/W dominator of presenting parr & maternal pelvis.

Cephalic ➡️ occipito (ant or post)
Face ➡️ mentum
Breech ➡️ sacrum
Shoulder ➡️ scapula


🔷Forces of labour:
1ry force,
uterine contraction which are👇

1. Painful ➡️ Colicky abdominal pain
2. Involuntary
3.Intermittent
4. Progressive
5. Coordinated
6. Effective ➡️ ass è cx diletation
7. Effacement ➡️ shortening of cx

2ry force

1. Voluntary bearing down
2. Cont of abdominal ms during full forced inspiration ➡️ help fetal descent

〰〰〰〰〰

🟣Symptoms of delivery:

1. True labour pain
2. Show ➡️ mucus stained with blood
3. Leaking

〰〰〰〰〰

⚪️Factor affecting cx diletation:

1. Uterine contraction
2. Pressure of bag of membrane
3. Prepare change in cx
4. Pressure of presenting part

〰〰〰〰〰〰

♦️1st stage of labour:

Started by true labour pain,
End by full diletation of cx (10 cm)

1. Latent phase ➡️ slow diletation of cx [3_4cm]
2. Active phase ➡️ rapid diletation of cx [10cm]

●Cervical diletation in active phase:
1cm/hr in primi
2cm/hr in multi

🟪MX of 1st stage of labour:

H/O 👇
gestational age, past medical _ surgical, Obstetrical H

DX 👇
Symptoms➡️ show, blood, ROM, abd examination

Vaginal examination ➡️ [cx diletation 2.5_3cm], consistency, effacement, position of cx, head station, presentation, position.

◽️Hospital admission criteria:

1. CX diletation [2.5_3cm]
2. 3_4 cont/10 min/55_60 sec duration
3. Pt in lateral position
4. Covering
5. Reassurance
6. Blood for HB
7. Cross match
8. IV fluid
9. Metoclopramide
10. Analgesic ➡️ pethidine, epidural analgesia
11. Catheter
12. Urine for➡️ ketones, protein, sugar
13. Vaginal examination /2_4 hrs
14. Pulse, BP, temp / 30 min
15. Episiotomy

〰〰〰〰〰〰

♦️2nd stage of labour:

1. Started by full diletation of cx
End by fetal delivery.

1. Engagement ➡️ passage of largest diameter of the presenting part through belvic brim

2. Descent➡️ Relation B/W presenting part & level of ischial spine.

3. Flexion
4. Internal rotation
5. Restitution
6. Extarnal rotation of shoulder

〰〰〰〰〰

♦️3rd stage of labour:

Started by fetal delivary
End by placental delivary

1. Phase of separation: painless uterine contraction
2. Phase of expulsion:

●Shultz method ➡️ placenta come down as inverted umbrella
●Metheu's Dunken method ➡️ placenta comes done by inferior edge

Med easy

#اللجنة_العلمية_للدفعة_السادسة
#Obstetrics
#Group_C

🟢Lie:
Relation B/W fetal long axis to maternal long axis

●Longitudinal lie ➡️ Both axis are parallel.
●Transverse lie ➡️ Both axis are perpendicular
●Oblique lie ➡️ Both axis crossing 45°