• Ultrasound showing uterus and tubal pregnancy

• Same image. Uterus outlined in red, uterine lining in green, ectopic pregnancy yellow. Fluid in uterus at blue circle - sometimes called a "pseudosac"

• Tx: laparatomy or laparascopic salphyngotomy or salphyngectomy

MOLAR PREGNANCY• Can be divide into:

– Complete mole– Partial mole

• Dx:– Hx and examination– Blood Ix : FBC, LFT, TFT, coagulation profile, B hCG– U/S : snowstorm appearance or bunch of grape : small vesicles and areas of hemorrhage– CXR– Tx : suction and curettage

x

xx

x

x

x

x

x

x

x

x

x

x

x

x

• There is a tapering of growth.

• asymmetrically smaller than gestational age.

• H/A is increased

2. Asymmetrical – HC/AC INCREASED

-Brain sparring due to placenta blood flow compromise

-Causes: placental insufficiency, severe maternal dis. Renal dis.idiopathic

• Fetus growing on the 5th percentile

• Symmetrically smaller than gestational age

• H/A is normal

x

xx

x

x

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Intrauterine Growth Restriction

-A fetus measured below the 10th percentile of weight for gestational age

-1. Symmetrical ( HC/AC normal)

- proportionate reduction of all fetal

parameters.

- prior to 26 weeks persisting until

delivery

- idiopathic( 90%)

-chrom.abnormality, TORCH,heavy

smoking, fetal alcoho

synd.undernutrition

NORMAL DOPPLER ULTRASOUND

ABSENT DIASTOLIC FLOW

REVERSE DIASTOLIC FLOW

Doppler Ultrasound

Umbilical artery Doppler:

Measuring the umbilical S/D ratio

Indicator for vascular resistance in placenta

Elevated S/D ratio indicates increase resistance

Absent/reversed diastolic flow indicates extremely high resistance in placental bed and associated with poor prognosis

http://www.medical.philips.com/main/products/ultrasound/assets/images/image_library/gyn_ovarianmass2820.jpg

MALIGNANCY

• USG features:– Bilateral– Size– Solid (or mixture)– Indeterminate border– Thickened capsule

wall– Breech capsule– Multiseptae– Papillary projection

– Presence of ascites– Doppler

• Increased vascularity

Ovarian Ca

• 90% epithelial tumour

• papillary serous cystadenoca, mucinous cystadenoca, endometroid cystadenoca

• Tx : surgery and chemotherapy

P C O S

• Presence of triad:– Hyperandrogenism– Disorder of menses– Subfertility

• USG features:– String of pearl

necklace– Dense ovarian stroma

• Ix:– Serum LH & FSH

(2-3:1)– Elevated androgen

(testosterone and androstenedione)

– Ele serum insulin

• Tx:– Anti-oetrogen:

clomiphen or tamoxifen

Spatula

• Ayer’s spatula• For cervical cytology/ papanicolou smear• a. ectocervix smear• B. fornix smearCIx: during mensus, sex within 24 hrs before the

test, no consent, virginHistology finding: (Bethesda sys)• Dyskaryotic: hyperchromasia / large nuclear to

cytoplasmic ratio• Increase mitotic cells

• Gonadotrophine releasing hormon analogue/agonist (GnRH) / Zoladex

• Indication: pseudomenopause= endometriosis and fibroid

• Side effects: hirsutism, hourseness of voice, bone loss, hot flush, night sweat

IUCD

• Intrauterine contraceptive device• action: 1.induced an inflammatory response in the

endomtrium that prevents implantation2. Toxic effect on sperm to prevent fertilization 3. Thicken cervical mucus and endometrium

(hormon)SE: PID, increase menstrual loss, dysmenorrhoea.: acne, breast tenderness, wt gain, spotting &

irregular bleeding (hormon)

OSCE 4 Depo provera

• Injectable progestogen / Medroxyprogesterone acetate

• IM• SE: wt gain, irregular mensus, delay in returning

fertility,others• Indication: PMS, painful period, cannot

remember to take pill• Action: inhibit ovulation, thicken cervical mucus,

reduce development of endometrium (thin and atrophy)

MgSO4

• Magnesium sulphate• prevention of fits in a woman with preeclampsia

or who has had eclampsia• Toxic effect (maternal) : respiratory depression,

cardiorespiratory arrest, hypotension• Earliest sign of toxicity : Loss of tendon reflexes• Neonatal hazard : Respiratory depression,

hypotonia, hypotension

Pessaries

• Pessary (ring, Hodge, shelf)

• Indication: uterovaginal prolapse, pt’s wish, not fit for surg, child bearing not complete, awaiting surg

• SE: vaginal ulcer, v discahrge, bleeding, discomfort, infection malignant change,

• Chnge 1 or 2 a year

Hormone

• A. LH

• B. FSH?

• C. progesterone

• D. estrogen

• E. inhibin

• Flisher’ clip• (female sterilization)• Cx : rupture, perforation, high risk of ectopic

pregnancy• Other alternative: falope ring, diathermy,

vasectomy• Advantages :

– Laparoscopic procedure – less invasive– Low failure rate– Reversib;e

• Tetanium

A

A. What are these instruments for? (1 mark)

B. What is the aim of this procedures (2 marks)

C. Name the instrument label A (2 marks)

D. Describe the procedures of concerned (5 marks)

• Fetal scalp PH instrument• To discover whether an abnormal FHR is due to fetal hypoxia and

to prevent severe asphysia• Amnioscopes• Pt is place on Lt lateral or lithotomy• Sterile tech. Appropriate size of amnioscope is inserted through

the cervix up against fetal scalp/breech.• Light source is attached. The presenting part is cleaned and

smear with silicone jelly.• Ethyl chloride is spray for 10 sec to produce hyperaemia. • Scalp/ buttock is stabbed once with guarded blade.• A continous column of blood (10-30 ul ) free of bubble of air is

collected in capillary tube.• Pressure is applied to secure bleeding.

OSCE 8• Name the instrument shown

• What is the use of this instrument

• Briefly describe the applications of this instrument

• List four possible complications associated with application of this instrument

• metal cup

• Vacuum delivery during 2nd stage of labour

• ant 2/3 of the posterior frontanel, as post as possible, not cover the frontanel and suture, head at +1 or +2 station.

• Tissue entrapment, laceration (M)

• Heamatoma, intracranial bleed(F)

• Simpson-Neville-Barnes forcep

• Prerequisity: inform consent, head engaged, cx fully dilated, suitable presenting part(vertex), empty bladder, suitable anesthesia.

• Cx: perineal tear, tissue entrapment,PPH

• Bruise mark, nerve palsy, skull #

twin

hyperstimulation

• Excessive oxytocin

• Stop oxytocin infusion, give O2, hydration

• Late deceleration• Causes(M): plc abruptio, mt hpotension,

excessive uterine act, DM, PIH, renal disease

• (F): IUGR, prematurity, tw-to-tw transfution, rh isoimmunisation

• Change mt posture, increase iv infution, O2, stop oxytocin, fetal blood smpling, prepare for delivery.

• Prolonged deceleration

• Cord prolapse, mt hypotension (epidural or local anaesthesia, uterine hypertonia

• Change mt posture, fluid, stop oxytocin, O2, VE for cord prolapse, check BP, prepare for delivery.

• Endometriosis

• Clinical features: dysmenorrhoea, menorrhagia, subfertility.

• Comfirm dx: laparoscopic examination

• tx.: med COCP, Mefenamic acid, GNRH analogue

• Sug: laser, adhesiolysis, diatomy

D & C set

• Ovum forcep – take out POC• Uterine sound – measure length & position of

uterus• Sharp currate – to scrap the endometrium (ant,

post, lateral n fundus wall)• Varselum teale – hold and pull cervix• Sim speculum – to visualize (by dr marion sims)• Hegar dilator – to dilate cervix (3mm – 18mm)

hysteroscope

Pipelle

• Name : pipelle de cornier

• For endometrial sampling

• Other alternatives ix: d&c , hysteroscopy

• Advantages ;– Can be conducted in outpatient setting– Cheaper– No anaesthesia required– Require minimal expertise

Hysterogram