World's Tragic In Medlife,.....You May Know Or Not: November 2012

Oral contraceptive complications: warning signs ACHES:

Abdominal pain
Chest pain
Headache (severe)
Eye (blurred vision)
Sharp leg pain

Abdominal pain: causes during pregnancy LARA CROFT:
Labour
Abruption of placenta
Rupture (eg. ectopic/ uterus)
Abortion
Cholestasis
Rectus sheath haematoma
Ovarian tumour
Fibroids
Torsion of uterus

Post-partum haemorrhage (PPH): causes 4 'T's:
Tissue (retained placenta)
Tone (uterine atony)
Trauma (traumatic delivery, episiotomy)
Thrombin (coagulation disorders, DIC)

Prenatal care questions ABCDEF:
Amniotic fluid leakage?
Bleeding vaginally?
Contractions?
Dysuria?
Edema?
Fetal movement?

Asherman syndrome features ASHERMAN:
Acquired Anomaly
Secondary to Surgery
Hysterosalpingography confirms diagnosis
Endometrial damage/ Eugonadotropic
Repeated uterine trauma
Missed Menses
Adhesions
Normal estrogen and progesterone

Gestation period, oocytes, vaginal pH, menstrual cycle: normal numbers 4 is the normal pH of the vagina.
40 weeks is the normal gestation period.
400 oocytes released between menarche and menopause.
400,000 oocytes present at puberty.
28 days in a normal menstrual cycle.
280 days (from last normal menstrual period) in a normal gestation period.

CVS and amniocentesis: when performed "Chorionic" has 9 letters and Chorionic villus sampling performed at 9 weeks gestation.
"AlphaFetoProtein" has 16 letters and it's measured at 16 weeks gestation.

Alpha-fetoprotein: causes for increased maternal serum AFP during pregnancy "Increased Maternal Serum Alpha Feto Protein":
Intestinal obstruction
Multiple gestation/ Miscalculation of gestational age/ Myeloschisis
Spina bifida cystica
Anencephaly/ Abdominal wall defect
Fetal death
Placental abruption

Alpha-fetoprotein: some major causes for increased maternal serum AFP during pregnancy TOLD:
Testicular tumours
Obituary (fetal death)
Liver: hepatomas
Defects (neural tube defects)

Female pelvis: shapes GAP:
· In order from most to least common:
Gynecoid
Android /Anthropoid
Platypelloid

Pelvic Inflammatory Disease (PID): complications I FACE PID:
Infertility
Fitz-Hugh-Curitis syndrome
Abscesses
Chronic pelvic pain
Ectopic pregnancy
Peritonitis
Intestinal obstruction
Disseminated: sepsis, endocarditis, arthritis, meninigitis

B-agonist tocolytic (C/I or warning) ABCDE:
Angina (Heart disease)
BP high
Chorioamnionitis
Diabetes
Excessive bleeding

Secondary amenorrhea: causes SOAP:
Stress
OCP
Anorexia
Pregnancy

Preeclampsia: classic triad PREeclampsia:
Proteinuria
Rising blood pressure
Edema

Dysfunctional uterine bleeding (DUB): 3 major causes DUB:
Don't ovulate (anovulation: 90% of cases)
Unusual corpus leuteum activity (prolonged or insufficient)
Birth control pills (since increases progesterone-estrogen ratio)

IUGR: causes IUGR:
Inherited: chromosomal and genetic disorders
Uterus: placental insufficency
General: maternal malnutrition, smoking
Rubella and other congenital infecton

Early cord clamping: indications RAPID CS:
Rh incompatibility
Asphyxia
Premature delivery
Infections
Diabetic mother
CS (caesarian section) previously, so the funda is RAPID CS

Oral contraceptives: side effects CONTRACEPTIVES:
Cholestatic jaundice
Oedema (corneal)
Nasal congestion
Thyroid dysfunction
Raised BP
Acne/ Alopecia/ Anaemia
Cerebrovascular disease
Elevated blood sugar
Porphyria/ Pigmentation/ Pancreatitis
Thromboembolism
Intracranial hypertension
Vomiting (progesterone only)
Erythema nodosum/ Extrapyramidal effects
Sensitivity to light

Forceps: indications for delivery FORCEPS:
Foetus alive
Os dilated
Ruptured membrane
Cervix taken up
Engagement of head
Presentation suitable
Sagittal suture in AP diameter of inlet

Delivery: instrumental delivery prerequisites AABBCCDDEE:
Analgesia
Antisepsis
Bowel empty
Bladder empty
Cephalic presentation
Consent
Dilated cervix
Disproportion (no CPD)
Engaged
Episiotomy

APGAR score components SHIRT:
Skin color: blue or pink
Heart rate: none, below 100 or over 100
Irritability (response to stimulation): none, grimace or cry
Respirations: irregular or good
Tone (muscle): some flexion or active

Postpartum collapse: causes HEPARINS:
Hemorrhage
Eclampsia
Pulmonary embolism
Amniotic fluid embolism
Regional anaethetic complications
Infarction (MI)
Neurogenic shock
Septic shock

Multiple pregnancy complications HI, PAPA:
Hydramnios (Poly)
IUGR
Preterm labour
Antepartum haemorrhage
Pre-eclampsia
Abortion

IUD: side effects PAINS:
Period that is late
Abdominal cramps
Increase in body temperature
Noticeable vaginal discharge
Spotting

Labour: preterm labor causes DISEASE:
Dehydration
Infection
Sex
Exercise (strenuous)
Activities
Stress
Environmental factor (job, etc)

Miscarriage: recurrent miscarriage causes RIBCAGE:
Radiation
Immune reaction
Bugs (infection)
Cervical incompetence
Anatomical anomaly (uterine septum etc.)
Genetic (aneuploidy, balanced translocation etc.)
Endocrine

Shoulder dystocia: management HELPER:
Call for Help
Episiotomy
Legs up [McRoberts position]
Pressure subrapubically [not on fundus]
Enter vagina for shoulder rotation
Reach for posterior shoulder and deliver posterior shoulder/ Return head into vagina [Zavanelli maneuver] for C-section/ Rupture clavicle or pubic symphisis

Labour: factors which determine rate and outcome of labour 3 P's:
Power: stength of uterine contractions
Passage: size of the pelvic inlet and outlet
Passenger: the fetus--is it big, small, have anomalies, alive or dead

Post-partum examination simplified checklist BUBBLES:
Breast
Uterus
Bowel
Bladder
Lochia
Episotomy
Surgical site (for Cesarean section)

RLQ pain: brief female differential

AEIOU:

Appendicitis/ Abscess
Ectopic pregnancy/ Endometriosis
Inflammatory disease (pelvic)/ IBD
Ovarian cyst (rupture, torsion)
Uteric colic/ Urinary stones

Post-partum haemmorrage (PPH): risk factors

PARTUM:

Polyhydroamnios/ Prolonged labour/ Previous cesarian
APH/ ANTH
Recent bleeding history
Twins
Uterine fibroids
Multiparity

Post-partum examination simplified checklist

BUBBLES:
Breast
Uterus
Bowel
Bladder
Lochia
Episiotomy
Surgical site (for Cesarean section)

Ovarian cancer: risk factors

"Blue FILM":

Breast cancer
Family history
Infertility
Low parity
Mumps

investigations ,PRENATAL DIAGNOSIS,timings

U-CAT
U............USG...............6-40WKS.
C...........CVS(chorionic villi sampling)................9-12
A..........AMNIOCENTESIS..15-18
T............TRIPLE TEST.......16-18

Spontaneous abortion: definition

"Spontaneous abortion" has less than 20 letters [it's exactly 19 letters].
Spontaneous abortion is defined as delivery or loss of products of conception at less than 20 weeks gestation.

Pelvic Inflammatory Disease (PID): causes, effects

"PID CAN be EPIC":

· Causes:
Chlamydia trachomatis
Actinomycetes
Neisseria gonorrhoeae

· Effects:
Ectopic
Pregnancy
Infertility
Chronic pain

Fetus: cardinal movements of fetus in

"Don't Forget I Enjoy Really Expensive Equipment":

Descent
Flexion
Interal rotation
Extension
Restitution
External rotation
Expulsion

Sexual response cycle

EXPLORE:

EXcitement
PLateau
Orgasmic
REsolution

Parity abbreviations (ie: G 3, P 2012)

"To Peace And Love":
T: of Term pregnancies
P: of Premature births
A: of Abortions (spontaneous or elective)
L: of Live births
· Describes the outcomes of the total number of pregnancies (Gravida).

FORCEPS/VACUUM DELIVERY

A - Anaesthesia/Assistance( anaesthetist, colleague,paediatrician) Think and prepare for shoulder dystocia
B- Bladder empty
C- Cervix fully dilated
D- determine position
E- Explain to the patient/ exit plan if it fails, ready for cesarean section
F - Fontanelle ( to check position )
G - Gentle traction
H- Handle elevated for forceps
Halt for vacuum ( no descent with 3 pulls, 3 times pop off )
I - Incision/Episiotomy
J- remove forceps when jaw visible

Indications of cesearian section

MICE CAME
M- Malpresentation
I- Induction failure
C- Cephalopelvic disproportion,contracted pelvis
E - Eclampsia
C- Cervical cancer
A- antepartum hemorrhge(Abruptio, placenta previa)
M- medical illness complicating pregnancy
E- Elderly primi

Omental caking: likeliest cause

Omental CAking = Ovarian CA
---"Omental caking" is term for ascities, plus a fixed upper abdominal and pelvic mass. Almost always signifies ovarian cancer.

Polycystic Ovarian Syndrome (PCOS): first line treatment
Treat PCOS with OCP's (oral contraceptive pills).

DYSTOCIA

CAUSES:Remeber 4 Ps.
Passenger (large baby)
Passage (Abnormal Pelvis)
Propulsion (uterine contraction)
Proportion (disproportion Cephalo-pelvic)

Antepartum hemorrhage (APH): major differential

APH:
Abruptio placentae
Placenta previa
Haemorrhage from the GU tract

Cardiotocogram (CTG) interpretation

Dr. C. BraVADO
Define Risk
Contractions (in 10 mins)
Baseline Rate (should be 110-160)
Variability (should be greater than 5)
Accelerations
Decelerations
Overall (normal or not)

PG E1 OR E2
CERVIPRIME HAS TWO Es SO IT MUST BE PROSTAGLANDIN E2 MISOPROSTOL - PG E1.

Smallest Fetal Head Diameter

M T P
Bi-Mastoid-7.5
Bi-Temporal-8.00
Bi-Parietal-8.5

1st stage of labour preriquisites

F- Fluids
R- Rest
A- Analgesia, epidural
M- Monitoring, foetal metarnal
E- Examination, vaginal or internal
D- Doctor, neonatologist obstetritician

5 P's of Septic Abortion ( clinical feature)
P- Pyrexia
P- Pain in abdomen
P- Pulse rate increase: 100-200/min
P- Purulent vaginal discharge
P- Pelvic findings: Patulous os or a boggy feel of the uterus

alfafeto protein in pregnancy
down in downs-syndrome
high in 2O-- O-OPEN NEURAL TUBE DEFECT
O-OMPHALOCELE

Antytb drugs in pregnancy

RIPE

R - RIFAMPICIN

I - ISONIAZID

P - PYRAZINAMIDE

E – ETHAMBUTOL

cord compression

LEV
PHC
late,early,variable
placental,head,cord compressin

DDx OF DECREASED FETAL MOMENTS:
DASH

Death of fetus
Amniotic fluid decreased
Sleep cycle of fetus
Hunger / Thrist

DECELERATION
H E A D
H(E A)D
EARLY DECELERATION

P L A C E N T A
P(LA)C E N T A
LATE DECELERATION

THEN UMBILICAL CORD COMPRESSION VARIABLE DECELERATION

diagnostic data of hydramnios

Its called RULE OF 2.
Polyhydramnios = amount of liquor 2L
Oligohydramnios = 0.2L
sonographically, poly = vertical pool 10-2 0r more
oligo = vertical pool 2 or less.
AFI, poly = 5^2
oligo = 10/2

HYD SA(O)MY DOWNFALL BCOZ OVER WT &AGE

CAUSES OF LOW MSAFP FETAL HYDROCEPHALUS,TRISOMY , DOWNS,FETAL CYSTIC FIBROSIS, MATERNAL OVER WT,GESTATIONAL AGE.

LABOUR EVENTS

EDF, ICE, RED,
E - Engagement
D - Descent
F - Flexion
I - Internal rotation
C - crowning
E - Extension
R - Restitution
E - External rotation
E - Delivery of limbs n shoulder.

Manning score (BPP)

"T.B. (tuburcular) MAN has manning score."
T-Tone of fetus
B-Breathing of fetus
M-Movement of fetus
A-Amniotic fluid volume
N-Nonstress test

Here "MAN" is also for "MANning score.".
It is also c/a BPP (Biophysical Profile)
Use for fetal monitoring.

medical condition improving in pregnancy

She Sleeps Slowly Dreaming Gets up in the Morning

She(female-SLE)
Sleeps(STD)-Syphilis
Slowly(slowly progressing)-Sarcoidosis
Dreaming(pain evening coming in dreams-Dysmenorrhea
Gets up (reduced sleep)-Graves
Morning- Migraine, M.Gravis

nonstress breathing movment to fluid

BPP NONSTRESS BREATHING MOVEMENT TO FLUID

POTTER'S SYNDROME.

remember this as........

POFTAR'S SYND (M>>F)

P=pulmonary hypoplasia;Potter's facies
O=oligohydramnios
F=facies
T=
A=autosomal recessive;anomalies-clubbing of the hands and feet and contractures
R=renal agenesis (Bilateral); recessive
'S=

PROSTAGLANDINS confusion

A)All have "1 MISS"
means
MISoprostol is PGE1.

B)cErviprimE has 2E so
cErviprimE is PGE2.

C)DInoproSTONE
DI=2
Remember that "stonE" in both(2) kidney n "stonE" has "E".
So DINOPROSTONE is PGE2.

D)DINO mario has 2 FArari CAR.
DINO-DINOPROST
2 FArari-F2A [A for Alpha]
CAR-CARBOPROST
so
DINOPROST n CARBOPROST r PGF2alpha

Note: DINOPROSTONE is PGE2 which is remember by 2 kidney stonE bt DINOPROST is PGF2alpha.

RSP-House

CHRONOLOGICAL APPEARANCE FETAL SIGNS ON USG------------
"REVOLUTINARY SOCIALIST PARTY HOUSE OR RSP-H"
R-RING (GESTATIONAL)-5TH WEEK
S-SAC (GESTATIONAL)-6TH WEEK
P-POLE (FETAL)-7TH WEEK
H-HEART(CARDIAC ACTIVITY) 8T WEEK

shine dalgaro sequence

text AUGUST
A
U
G
THIS IS THE SEQUENCE

signs of pregnancy

1st trimester
George Bush’s Social Conscience Focuses From Pathetic Humor Upto Violent Heavy Poetry About Prime Minister Of Jailhouse Camp

G=Goodell’s sign
B=breast signs
S=sonography
C=cervical changes
F=fatigue
F=frequency of micturition
P=Palmer’s sign
H=Hegar’s sign
U=uterine changes
V=vaginal wall
H=hCG levels
P=Piskacek’s sign
A=amenorrhea
P=placental sign
M=morning sickness
O=Osiander’s sign
J=Jacquemier’s sign
C=crown rump length

2nd trimester
Bush’s Cheap Stunt For Reelection, Focused Upon Firing At Baghdad’s Locals & Society, Backfired Since Army Behaved Questionably

B=Breast changes
C=chloasma
S=sonography
F=fundal height
R=radiological signs
F=fetal parts palpated
U=uterine changes
F=FHS
A=amenorrhoea
B=Braxton Hicks Contractions
L=linea nigra
S=striae
B=ballottement
S=soft cervix
A=active fetal movements
B=blue cervix
Q=Quickening

3rd trimester
Feeling Freed By Firing Field Focused Completely Upon Foreigners in Baghdad, American Leaders & Society Slept.

F=frequency
F=fetal movement
B=breast changes
F=fundal height
F=fetal movements
F=fetal parts palpated
C=cutaneous changes
U=uterine shape
F=FHS
B=Braxton Hicks contractions
A=amenorrhoea
L=Lightening
S=Symphysis Fundal Height
S=sonography

Suppress Preterm Labour with "PASTA"

P = Pain relief
A = Antibiotics
S = Steroid Therapy
T = Tocolytics
A = After Ascertaining An Aetiology

Test the Baby,MAN!

When performing a BPP,remember to_

Test the Baby, MAN!
Fetal Tone
Fetal Breathing
Fetal Movement
Amniotic fluid volume
Nonstress test

TYPES OF DECELERATIONS DURING PREGNANCY DOPPLER

1st/early 2 deliver=head

last/late=placenta

So..early declaration d/t head compression &late deceleration d/t placental insufficiency

variable declaration=cord compression(cord can be delivered anytime eg, cord prolapse or after baby =variable)

Ovarian cancers: important types, by WHO classification ·
Surface:
"My Sister Began Experiencing Cancer":
Mucinous
Serous
Brenner
Endometrioid
Clear
· Germ cell:
"Doctor Examined The Ovaries":
Dysgerminoma
Endodermal sinus
Teratoma
Ovarian choriocarcinoma
· Sex cord:
"She Felt Grim":
Sertoli-Leydig
Fibroma
Granulosa-theca
· Metastatic
"Killed":
Krukenberg

Antihypertensives in Pregnancy:
(B)etter (M)other (C)are (D)uring (H)ypertensive
(P)regnancy
B-Beta blockers(labetalol)
M-Methyldopa(D.O.C)
C-Clonidine,CCBs
D-Dihydropyridine
H-Hydralazine(D.O.C in hypertensiv emergency)
P-Prazosin

Progesterone: actions
PROGESTE:
Produce cervical mucous
Relax uterine smooth muscle
Oxycotin sensitivity down
Gonadotropin [FSH, LH] secretions down
Endometrial spiral arteries and secretions up
Sustain pregnancy
Temperature up / Tit development
Excitability of myometrium down