Common Question Obs & Gyne

Mohammed Kamal
Ahmed MA`
Gestational diabetes
Screening test >>> 50 mg 1h test ( GCT ).

Confirmatory test >>> 100 mg 3h test ( GTT ).
Fasting blood sugar above 95 alone is diagnostic.
Fasting normal, two of readings should be high.
If only one . Impaired glucose tolerance.
Insulin
o Production increase
o T1/2 does not change
o R increase.
At 22w U/S to detect cardiac anomalies
If blood sugar well control >>> No delivery before 38.
Monitor Pt during labor to avoid hypoglycemia
12w U/S nuchal translucency >>> accumulation of fluid posterior to neck.
When obstructive labor occurs dont put your hand because you well tear the cervix
so >>>> CS.
Chorioamnionitis
Maternal fever more than 38, lecocutosis

Maternal tachycardia
Fetal tachycardia
Uterine tenderness
Malodorous vaginal discharge
Placenta previa:
Recurrent
Painless
Causeless
Ante D and kleihauer betke test

1. Indications
1.Measures fetal cells in maternal circulation
2.Used in assessing for Rh Sensitization
Mohammed Kamal
Ahmed MA`
1. Maternal blood Rh negative

2. Large antepartum bleed
2. Mechanism
1.Blood Film stained with acid elution
2.Fetal Hgb more acid resistant
3.Fetal RBC darkly stained, Maternal RBC "ghosts"
3. Technique
1.Count Fetal cells per 50 low power fields
2.Five cells per 50 (lpf) = 0.5 ml bleed
4. Interpretation
1.Rh Immune Globulin (RhoGAM) Dose
1. Give 300 ug per 30 ml fetal whole blood or 15 ml pRBC
Cytotec dose:
For IOL: tablet every 6 hours
For induction of abortion 1 tablet every 4 hours
1tablet = 200 ug
PROM
Definition: rupture of the membranes prior to the onset of labor.
PPROM is defined as rupture of membranes (amniorrhexis) before 37 weeks gestation.
General management
Each day vital signs
Each 3 days CBC
Fetal tachycardia occurs before maternal tachycardia
If occurred before 36 weeks:
Give dexamethasone if before 34 weeks
Cover with erthromycin
Do your best to reach 36 weeks then deliver the baby
If occurred after 36 weeks:
Give the patient 24 hours for spontaneous delivery, more than 80% will deliver
Mohammed Kamal
Ahmed MA`
If delivery doesnt happen, induce the labor and cover the patient with AB
Ectopic pregnancy
More than 1500 to 2000 mIU/mL of hCG without gestational sac by transvaginal US
More than 5200 to 6000 mIU/mL of hCG without gestational sac by abdominal US
Imperforated hymen
Abdominal pain
Amenorrhea
Urine retention
Haematocorpus
Vaginal discharge
Clue cells are epithelial cells of the vagina that get their distinctive stippled appearance
by being covered with bacteria.
Mohammed Kamal
Ahmed MA`
Abortion
No role of progestin in threatened abortion
Before 8 weeks, the corpus luteum is the main producer of progestin, after that the
placenta takes place
We can distinguished between complete and in complete abortion by thickness of the

endometrium if more than 15mm it incomplete.
Amniotic fluid
Before 16w Maternal source: Firstly water-like fluid originates from the maternal
plasma, and passes through the fetal membranes by osmotic and hydrostatic forces
After 16w fetal source: first as transudation from non-keratinized skin till 25 weeks
when skin keratinization is complete then urination and swallowing take place
Umbilical cord
30-100 cm
8 coils
2 artery and 1 vein
Placenta
500 gm or 1/6 weight of the baby
Presumptive signs and symptoms of pregnancy
Amenorrhea
Nausea and Vomiting (Morning Sickness).
Frequent Urination.
Breast Changes.
(a) Darkening of the areola.
Mohammed Kamal
Ahmed MA`
(b) Enlargement of Montgomery

(c) Increased firmness or tenderness of the breasts.
(d) More prominent and visible veins.
(e) Presence of colostrum. This can be expressed during the second trimester.
Vaginal Changes.
(1) Chadwick's sign. The vaginal walls have taken on a deeper
(2) Leukorrhea. This is an increase in the white or slightly gray mucoid discharge that has
a faint musty odor.
Skin Changes.
Striae gravidarum (stretch marks).
Linea nigra.
Chloasma. This is called the "Mask of Pregnancy." It is seen after the sixteenth week of
pregnancy.
Probable signs of pregnancy
Position. By the 12 week, the uterus rises above the symphysis pubis and it should
reach the xiphoid process by the 36th week of pregnancy
Size. The uterine increases in width and length approximately five times its normal
size. Its weight increases from 50 grams to 1,000 grams
Hegar's sign. This is softening of the lower uterine segment just above the cervix.
Ballottement. This is demonstrated during the bimanual exam at the 16th to 20th
week.
Positive signs of pregnancy

Fetal Heart Sounds . It is audible with a doppler by 10 weeks of pregnancy and with a
fetoscope after the 16th week
Ultrasound Scanning of the Fetus.
At booking to confirm pregnancy
22w detailed scan
34w check the growth
Palpation of the Entire Fetus. after the 24th week of pregnancy if the woman is not
obese.
Palpation of Fetal Movement.
Mohammed Kamal
Presenting Part
Vertex (occiptoanterior)
occipitoposterior
Face
Braw
Buttocks
Feet
Shoulder, arm
Ahmed MA`
Denominator
Occiput (O)
Occiput (O)
Mentum (chin) (M)
Frontum (forehead) (Fr)
Sacrum (S)
Sacrum (S)
Scapula (Sc)
Engaged Diameter
Suboccipitobregmatic (9.5 cm)
Occipitofrontal (11 cm)
Submentobregmatic (9.5 cm)
mento-vertical diameter l (13.5 cm)
Inter-trochantric (10cm)
Inter-trochantric (10 cm)
Bi-acromial (12 cm)
How to examine blood pressure
Rest the patient for 10 mint.

The position of patient is supine or upright position.
Ask the patient about smoking and coffee drink.
The size of cuff must cover about two third of arm.
Put the cuff about 1-2 cm above the cubital fossa.
Raise the pressure about 20mmhg above her last blood pressure value.
First sound is systolic and the fourth sound (when the sound becomes muffled) is
diastolic.
Common sites for edema:
Shin of the tibia most important

Lateral malleolus
Medial malleolus
Navicular bone
Periorbital
Sacrum
Abdomen ascites
Anasarca

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Mohammed Kamal

Screening test >>> 50 mg 1h test ( GCT ).

Maternal fever more than 38, lecocutosis

Ante D and kleihauer betke test

1. Maternal blood Rh negative

Each day vital signs

Each 3 days CBC

Fetal tachycardia occurs before maternal tachycardia

If occurred before 36 weeks:

Give dexamethasone if before 34 weeks

Cover with erthromycin

Do your best to reach 36 weeks then deliver the baby

If occurred after 36 weeks:

We can distinguished between complete and in complete abortion by thickness of the

2 artery and 1 vein

500 gm or 1/6 weight of the baby

Presumptive signs and symptoms of pregnancy

(a) Darkening of the areola.

(b) Enlargement of Montgomery

Probable signs of pregnancy

Positive signs of pregnancy

How to examine blood pressure

Rest the patient for 10 mint.

Common sites for edema:

Shin of the tibia most important

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