Youngest mother in the world to give birth

Precocious Puberty

Youngest mother in the world to give birth in 1940

STD's with Ulcers and No Ulcers

STD's 

With Ulcers :

Syphilis (Painless)
LGV
Genital herpes (Painful)
Granuloma inguinale
Chancroid (Painful)

No ULCERS 

Chlamydia
HPV
Gonorrhea
Hepatitis B
HIV

Leiomyoma vs Adenomyosis - USMLE

Enlarged Uterus

Leiomyoma and Adenomyosis (Non-Pregnant) 

Urinary Incontinence and its types (Stress , Urge , Overflow , Bypass & Irritative)

Early vs Late Congenital Syphilis

Early congenital syphilis :

• Non - immune hydrops
• Macerated skin 
• Thrombocytopenia

Late congenital syphilis :

• Hutchinson teeth
• Mulberry molars
• Saber shins

Clinical Manifestations of Congenital Infections

Clinical Manifestations of Congenital Infections 

Highlight on 

CMV : Petechiae

Toxo : Chorioretinitis & Cranial Calcifications

Couvelaire uterus - (Abruptio Placenta)

It is pathological entity in association with severe form of concealed abruption placenta
There is massive intravasation of blood into the uterine musculature upto the serous coat.
The condition can only be diagnosed on laparotomy

Types of Miscarriage

Threatened 

• Vaginal bleeding
• Closed cervical os
• Fetal cardiac activity

Missed

• No vaginal bleeding
• Closed cervical os
• No fetal cardiac activity or empty sac

Inevitable

• Vaginal bleeding
• Dilated cervical os
• Products of conception may be seen or felt at or above cervical os

Incomplete 

• Vaginal bleeding
• Dilated cervical os 
• Some products of conception expelled and some remain

Complete

• Vaginal bleeding or none
• Closed cervical os 
• Products of conception completely expelled

Placental implantation

Placental implantation. (A)  Normal placenta.  (B)  Low implantation.  (C)  Partial placenta  previa.  (D)  Complete placenta  previa.

OBSTETRIC ANALGESIA AND ANESTHESIA

Uterine contractions and  cervical dilation  result in visceral pain (T10-L1).
Descent of  the  fetal  head and pressure on  the  vagina and perineum  result in somatic pain (pudendal nerve, S2-S4).
In the  absence  of a  medical  contraindication,  maternal  request  is  a  sufficient medical indication for pain relief  during labor.

Absolute  contraindications  to  regional  anesthesia  (epidural,  spinal,  or 
combination) include the following: 

• Refractory maternal hypotension 
• Maternal coagulopathy 
• Maternal  use  of  a  once-daily  close  of  low-molecular-weight heparin within  12  hours 
• Untreated  maternal bacteremia 
• Skin infection over the site  of  needle placement 
• Increase in  ICP caused by a mass lesion

WEEKS PRENATAL DIAGNOSTIC TESTING

Prenatal Diagnostic Testing Schedule

WEEKS  PRENATAL  DIAGNOSTIC TESTING

Prenatal visits  

• Weeks 0-28: Every 4 weeks. 
• Weeks 29-35: Every 2 weeks. 
• Weeks 36-birth: Every week. 

Initial visit :

Heme:  CBC, Rh factor ,  type  and  screen.

Infectious disease:

UA and culture,  rubella  antibody titer , HBsAg,
RPR/VDRL, cervical gonorrhea and chlamydia, PPD, HIV,  Pap
smear (to check for dysplasia). Consider HCV and varicella based
on history.

If indicated: HbA, sickle cell screening.
Discuss genetic screening:  Tay-Sachs disease, cystic fibrosis.

9- 14  weeks :

Offer PAPP-A +  nuchal transparency + free  B-hCG +/- chorionic
villus sampling  (CVS)

15-22 weeks :

Offer maternal  serum a-fetoprotein  (MSAFP)  or quad screen  (AFP,
estriol,  P-hCG, and inhibin A)  +/- amniocentesis.

18-20 weeks :

Ultrasound for full  anatomic screen.

24-28 weeks : 

One-hour glucose  challenge test for gestational diabetes screen.

28-30 weeks :

RhoGAM for  Rh-8 women (after antibody screen).

35-40 weeks :

Group  B  strep  culture  (GBS);  repeat CBC.

34-40 weeks :

Cervical chlamydia  and  gonorrhea cultu res,  HIV,  RPR  in high-risk patients.

Cervical insufficiency (incompetent cervix)

Painless early pregnancy dilation

Etiology

• Trauma from rapid forceful cervical dilation associated with 2nd trimester abortion
• Cervical laceration from rapid delivery
• Injury from deep cervical cone
• Congenital weakness from DES exposure

Diagnosis:

• History of 2 or more unexplained second trimester pregnancy losses.
• Benefit of cerclage is unclear  

Management: 

• Elective cerclage at 13-16 weeks gestation
• Emergency or Urgent cerclage
• Cerclage removal at 36-37 weeks

Fetoscopy

When to perform : 18-20 weeks

• its for Biopsy of fetal tissue and IU surgery
• Loss rate : 2-5 % 

Safe Motherhood initiative (ACOG)

These images are provided by ACOG (American Congress of Obstetricians and Gynecologists)

First Line Management with Hydralazine

 First Line Management with Labetalol

OBG Multiple Choice Questions

 

Maternity Blues,Postpartum Depression and Postpartum Psychosis