Med notes 🩺

⚪️Placenta accreta: chorionic villi attach to the myometrium (but do not invade or penetrate the myometrium)

⚪️Placenta increta: chorionic villi invade or penetrate into the myometrium

⚪️Placenta percreta: chorionic villi penetrate the myometrium, penetrate the serosa, and in some cases, adjacent organs/structures

APS "Laboratory- The presence of aPL":
1.IgG and/or IgM aCL( Anticardiolipin Ab)
2.Antibodies to ß2-glycoprotein I
3.Lupus anticoagulant (LA)

most important indication to give progesterone in 1st trimester is IVF

🔸The most important risk factor in endometrial cancer is OBESIETY

PG:
🔻PGE1 — misoprostol
✅IOL: PGE1 ( Misoprestol- Cytotec) is applied in the form of vaginal tablet 25µg
✅PPH , cause SE: diarrhea HYPOTHERMIA
🔻PGF2 alpha — carboprost
✅ Used for PPH, IM , CI: asthma (cause sever vasospasm

🔻PGE2 — Prostin (IOL)
✅PGE2 ( Prostin ) is applied in the form of vaginal pessary 3 mg or intracervical gel 0.5mg.

Normal Uroflowmetry:

Postvoid residual volume (PVR) PVR of
- < 50 mL is adequate emptying,
- a PVR > 200 mL is considered inadequate


First desire to void → occur between 150 & 250 mL
Strong desire to void → doesn’t occur until > 250 mL

Bladder compliance → between 400 & 600 mL

No uninhibited destructor contraction during filling, despite provocation
No stress or urge incontinence
Voiding occurs because of voluntarily initiated & sustained detrusor contraction


Flow rate during voiding is > 15 mL / sec with detrusor pressure of < 50 cm H2O

FSH >25 IU/L is characteristic of the late -menopausal transition,

⚪️Phases of menopause
🔻 Perimenopause: Begins with the first clinical, biological and endocrinological features of the approaching menopause and terminating with the completion of menopause

🔻Menopause — retrospectively after a woman has experienced 12 months of amenorrhea

🔻Post-menopausIt— is the time after which a women has experienced 12 consecutive month of amenorrhea

leiomyosarcoma:
➔5-10% of leiomyosarcoma arise from fibromyoma
➔95-90% arise from normal myometrium
➔0.2% of fibromyoma transformed to leiomyosarcoma
➔ In 80%,diagnosis is made after hysterectomy

lifetime risk of developing:
🔸cervical cancer is 0.76%
🔸ovarian cancer 1%

Human papillomavirus (HPV) is central to the development of cervical neoplasia and can be detected in 99.7%

40 genital mucosal HPV types identified, approximately 15 are known to be oncogenic.

Subtypes HPV 16 , 18 found in over 70 percent of all cervical cancers.

Numerical notes In DM:

1- Diagnosis GDM:
✅(NICE) guidelines (2015) recommend a diagnosis of GDM with a:
🔽fasting glucose ≥101 mg/dl and/or
🔽2 hour (post-75 g glucose load) of 140 mg/dl.

✅The WHO guidelines (2013) recommend a diagnosis with a
🔽 fasting glucose of 92mg/dl
🔽1 hour (post 75 g glucose load) of 180mg/dl or
🔽2 hour of 153mg/dl


2- Timing of screening:
✅ If risk factors are present, the woman should be offered a 2-hour75 g oral glucose tolerance test (OGTT) at 24–28 weeks’ gestation.
✅Women with previous history of GDM should have an oral glucose tolerance test at 16–18 weeks’ gestation. The test should be repeated at 24–28 weeks of pregnancy.

3- Chronic DM:
✅ The Hb1C before pregnancy must be: less 6% (42mmol/mol)
✅ Targets for therapy pre-pregnancy are:premeal glucose levels of 72-126 mg/dl .
✅ During pregnancy targets of:
🔽before meal: <96 mg/dl
🔽1-hour postprandial levelsof <140 mg/dl .
✅maternal blood glucose levels maintained at 4–7 mmol/l to reduce risk of neonatal hypoglycaemia.
4- -The level of HbA1c in early pregnancy also correlates with the risk of early fetal loss.
✅An HbA1c of >9.8% fetal loss during pregnancy of around 30%.


5- Women with diabetes should be offered a fetal anomaly scan at 19–20 weeks with an assessment of the cardiac outflow tracts


6-After 6 -12 weeks of delivery we have to do HB1AC :
Back to normal / <6 it was GDM
borderline 6-7 she has a risk to develop clinical DM
More than 7 : its clinical DM.

Leopold’s maneuvers

Malpresentation numerical notes:
- incidence of breech presentation: 3–4% of term pregnancies: MOST common malpresentation
- most common breech presentation — frank (extended)

- breech presentation is clinically suspected at or after 36 weeks, this should be confirmed by thorough ultrasound scan

- success rate of ECV > 50% " more in multipara"

- ECV done 36-37 W

- Mortality of breech fetuses in vaginal delivery is about 2.5%

- At onset of labor, 10% of vertex presentations are occipitoposterior. 2/3rds are a result of malrotation of the occipitoanterior position.
- 80% rotate to occipitoanterior during labour.

- face presentation: 1:500 delivary
🔸 60%: Mento-anterior
🔸15% meto-transverse
🔸25% mento-posterior


- incidence shoulder presentation — less than 1%

Numerical note in infertility lecture:
Serum Progesterone: above 4 ng/ml in midluteal phase —presumptive evidence of ovulation

Day 3 FSH (normal < 10 mIU/mL)


How many eggs are we dealing with?
• 20 weeks of gestation in utero: 2-5 million primordial follicles arrested at prophase I of meiosis.
• Birth: 1-2 million
• Puberty: 300-500 000
• Majority will be lost to atresia
• Ovulate: 400-500 lifetime cycles
• Menopause: < 1000


Uterine/Tubal Factor: 30% of all infertile couples
10-15% of infertile females are anovulatory.
Clomiphene outcome: 40 % cumulative pregnancy rate.

eight to 14 days of stimulation are needed in case IVF
egg retrieval is performed usually 34 - 36 hours after hCG injection.

Fertilization is started by adding 10,000-50,000 motile sperms to about 100 µl to 1 ml culture medium in which the oocyte

Fertilization check is performed the next day approximately 18 hours after sperm injection or insemination of the eggs —> 65% to 75% of mature eggs will fertilize after insemination

Embryo transfer may be performed on day 2, 3 or 5 post fertilization.

How Many Embryos are Transferred?
o <35 = 2
o >35 = 3



🔻 Success >35% depending on the age and infertility diagnoses of the candidates

OHSS:

⚪️Fecundability: The probability of conceiving in a single cycle (a more immediate or short-term measure).
⚪️Fecundity: The biological potential to reproduce, often looking at the long-term ability to have children (a more general or long-term measure).

PG:
PGE1 — misoprostol
PGF2 alpha — carboprost
PGE2 — Prostin

يعطيكم العافية
في هاي القناة تفاريغ النسائية مرتبة:
https://t.me/obs_gyn_sheet

biomarker in Down syndrome (screening) :

Duration of Pregnancy
- Average 280 days or 40 wks. (9 lunar months)

How long is labour ?
- On average, labour lasts 12-18 hrs in a woman's first pregnancy “primary gravida” .
- and tends to be shorter, & averaging 6-8 hrs, in subsequent pregnancies .
» Normal: More 3 hr, less 18 hr

When does normal labour start ?
- Labour usually starts between 37 - 42 wks. (3 wks before or 2 wks after the (E.D.D)

Every how must do vaginal exam during labor?
every 4hr (nulli) every 2 hr (multipara)

Longest STAGE — 1st
SHORTEST — 3rd


1st stage:
- latent — 8 hrs at nulliparous, 3 hrs at multiparous
❌ Prolonged latent phase – >20 hrs in the nulliparous, >14 hrs in the multipara .

3rd stage Duration:- 5-30 min

4th stage of labor: Duration is first 6 hrs after delivery.

Adenomyosis
- C/P of adenomyosis: 40 year female, multipara, complains of Menorrhagia
-Dx of Adenomyosis: Retrospectively After hysterectomy (histology study)
-Physical Exam: LARGE REGULAR TENDER UTERUS
-Treatment of adenomyosis: Hysterectomy WITHOUT Bilateral Oophorectomy

Fibroid
- Nullipara
- PE: LARGE IRREGULAR PAINLESS UTERUS

Endometriosis:
-C/P: chronic pelvic pain, 2ry dysmenorrhea, DEEP dyspareunia, Infertility
-Dx: Laparoscopy
-Surgical treatment of endometriosis: Bilateral Oophorectomy With hysterectomy

Eccentric (velamentous) Cord insertion
Abnormal cord insertion into chorioamniotic membranes, resulting in exposed vessels only surrounded by thin fetal membranes, in the absence of protective Wharton jelly

Sinus vs Fistula
🔹Fistlula abnormal opening or passage between two organs or between an organ and the surface of the body.
🔹sinus tract is an abnormal channel that originates or ends in one opening

RF:
weakened immune system (e.g., diabetes mellitus, alcohol use disorder, obesity, use of corticosteroids, or chemotherapy), a recent history of surgery, or trauma to the perineum or scrotum.

Fournier gangrene:
🔸Necrotizing fasciitis of the external genitalia that can spread rapidly to the anterior abdominal wall and gluteal muscles.
🔸 usually mixed infection with facultative pathogens (E. coli, Klebsiella, Enterococcus) and anaerobic bacteria

Necrotizing soft tissue infections are a surgical emergency. Expedite and prioritize surgical exploration for diagnostic confirmation and debridement as much as possible!

Charcot joint acute vs chronic

cancer & tumor marker
gallblader Ca — ca 19-9
cholangio Ca — ca 19-9
pancreaticCa— ca 19-9
Liver Ca— AFP
CRC—CEA

Stermmer's sign

structure pass through parotid gland:

Hirshprung disease

alvardo score

SCC