1.
Indication , types , how to perform it.
2.
3.
IUCD pic : what is this? Indication? Complications.
4.
Fibroids pic : what is this? Symptoms, complications during pregnancy.
5.
Placental abruption pic : what is this? Complications for fetus & mother, co conditions, treatment.
6.
Anencephaly pic : what is this? How to diagnose? Complications.
7.
CTG… read it …. What is your plan?
8.
HSG pic showing blocked tubes…. What do u see? Give another test to assess patency of tubes? What is your plan….
Station 1:
Vaginal bleeding in the 3rd trimester "Ante-partum hemorrhage either placenta previa or abruptio placenta I can't remember" (Hx and management)
Station 2:
Vaginal bleeding in the 1st trimester (Hx and management).
كانت .inevitable abortion
Station 3:
Pregnant lady who has also fibroid in the lower part of the uterus (how to deliver and the type of the incision) and if she developed after the delivery DVT what is the cause and the management
Station 4:
Gestational diabetes (the tests and the management).
Station 5:
Instruments (what is the instrument and what is used for).
Station 6:
Lady presented with vaginal discharge (Hx, investigations and treatment).
Station 7:
Partogram with information on it (what is the problem and the management)
كانتfailure to progress in the second stage على ما اذكر و الـ management
Block 3 :
Case1: (Endometriosis)
The Dr gave typical Hx of endometriosis.then he asked:
what is your diagnosis?
what investigations to confirm?
what is the most definitive diagnostic way?
what are the lines of treatment?
Case2: (Normal Labor, Induction of Labor)
1.what do you want to see in your examination?
2.when to decide doing cesarean?
-you should know when to do CTG, scalp PH sampling.
- you should know how frequent to do PV & repeat PH & CTG ,what is the next step in each case.
Case3:(Partogram)
you should know patterns of dysfnctional labor &management of labor.
you should know how to read partogram & pickup needed information.
Case4: (Galactorrhea)
Presentation with excessive milk production + Inferitlity.
what this condition is called?
what is the m0ost likely diagnosis? Hyperprolactinemia.
what physical exmination to do? Visual field.
what investigations? Hormone profile(prolactin FSH,LH) +CT brain for pituitary adenoma.
In a case of of infertility,.
what is the key lab investigation? Progesterone level at day 21.
If hormonal profile &ovarian fxn were normal in a subfertile female, what is your next step? Hysterosalpingogram to check uterus and tubes.
Case5: (Ovarian mass)
when to suspect cancer?
what investigations?
what is your management?
Case 6:
Pregnant lady with Hx of 2 DVTs ,want to do Cesarean (indicated C\S)
when to start heparin as prophylaxis during pregnancy?
when to stop?
when to give after C\S? for how long.
Case7:OCP
tell me about OCPs.
the ptn was lactating &want to take OCP what you will tell her?
Questions past year from Dr Khaled Badi’ah Hospital
27yo pt, G3P2, both NVD, 3.5 kg, seen for routine natal visit at 38w, no significant hx
On exam : BP 120/70
Obs exam : Breech presentation
1. Whats ur next step?
- pelvimetry/ultrasound
2. U/S done shows breech, otherwise others is normal, pt ask you – how to deliver?
- 3 option : Breech Vaginal delivery/ECV then NVD/ c/s
3. She decided Vaginal delivery and ECV, whats the success rate?
- 50%
4. What are possible complication of ECV?
- Failure of ECV
- Cord compression
- ROM
- Placenta Abruptio
- Ruptur uterus
- Fetal distress
- Feto Maternal silent hemorrhage
5. ECV failed(which means the complication above happen),then what?
-do ELECTIVE c/s after 1 or 2 days waiting.
48yo, referred from private doc case of menorrhagia for further evaluation and treatment
(answer as in dr fayed jallad notes and in his lecture)
1. What are the possible cause?
-organic cause
-non organic
2. Step that should be taken?
-Hx : bleeding(analysis), previous treatment n drugs taken, prev biopsy/smear, thyroid/blood/liver disease
-PE :
1.General : anemia sign, breast,thyroid disease
2. Abdominal ; palpable mass
3. Pelvic : inspection, speculum, bimanual
Bimanual exam :
-uterus size(huge,bulky,normal), shape(resular/irregular)
-mobility : mobile/fix
-position : anterverted(cervix felt anterior)/retro (cervix felt posteriorly)– important to insert the sounds
-Investigation : (6) CBC, Coagulation, TFT,LFT,Cervical smear,endometrial smapling by DnC
3. After investigation no organis cause identified, then whats the cause?
-DUB
4. Treatment?(elaborate the answers)
1. Medical
2. Surgical
A pictures shows P.previa grade 3 and malpresentation(breech)
1. What do u see the clinical problem in this pic?
- PP and malpresentation
2. Whats the usual presentation?
- Painless vaginal bleeding
3. Give 4 complication
PPH, maternal morbidity and mortality, Fetal M& M, preterm delivery
4. Mx?
1. Admission
2. 2 large bore canula, draw blood for cbc(Hb), crossmatch, blood group, Prepare 4 unit blood
3. Fetal maternal monitoring : ……..
4. Dexametasone 2x 12h apart 12mg, Rhogam(anti D)
5. When to deliver?
-wait at 37-38w to deliver by ELECTIVE C/S
If bleeding sever, fetal Distress, contaction indicate labour à EMERGENT C/S
38yo, G3P2, 2 NVD, 2 healthy boy, 32 w GA, singleton, came to ER c/o abd pain for the last 5h. She is medically fit(which mean uneventful pregnancy), take relevant hx…
1. Analysis of pain – mild progressive colicky, for how long and the frequency?- every 5 min, lact 20sec each
2. Bleeding? – no
3. Passing liquor? – no
4. Fetal movement – good
5. Fever ? – no
6. G1 symptoms/ urinary sx
7. Feeling pressure down ?– IMPORTANT! DON’T FORGET!
8. Passage of SHOW ?
9. Trauma
IUCD questions…
1. What the type IUCD u know? Copper and mirena
2. What imp point in pt taking IUCD?
(7) allergy copper, PID hx, ectopic Hx, LMP(make sure she is not pregnant), Previous failure IUCD, systemic illness(if have infective endocarditis we cant give them IUD), sign of vaginal infection
3. When to insert? Any day provided not pregnant, preferably on 5th day menses.
4. Caunseling complication
- Perforation, failure IUCD increase risk ectopi, PID, menorrhagia
- Mild cramping pain and slight bleeding
- Fainting(dizziness)
- Risk od PID in 1st few months
- IUCD need to be f/up and check
- Failure rate/perforation
- Usual time perforation during insertion
- If spill out – do u/cs à if not seen, do abdominal xray à seen radio opage
Primigravida, 36w GA, PROM since 24h + uterin e contraction
On exam : Obese, normal U/S
Vaginal Exam : 3cm dilated cervix + cord prolapsed, vertex presentation 3 cm above the ischial spine, FHR 100b/min(deceleration)
1. Whats definitive tt? - EMERGENT C/S
2. 6 possible post op complication?
Thrombosis, resp infectn, endomeritis, bleeding, UTI etc
3. How to decrease the complication?
-prophylaxis low molecular weight heparin and others(look in C/s notes)
4. 2nd week after delivery, where will be the uterus?
-Pelvic Organ
5. 6 week post-del, lactationg, wish to use contraceptive, options?
- Minipills, mirena, depopovera,implant
6. What chances of this mom to deliver NVD the next time?
65 – 80%
Miss A, G4P3, all deliver by NVD, attend at 35w for 1st time, no medical illness, normotensive
Abdominal exam – singleton,tranverse lie, fetus good
1. Abdominal u/s perform, what to look for?
1. Placental localization
2. Amount of liquor
3. Confirm GA + live fetus
4. Congenital anomalies
5. Uterine anomalies
2. u/s done – single fetus, equal GA, tranverse lie, no gross anomalies, aFI 12, placenta ant reaching cervix
dx ? – Pprevia GRADE 2-3
3. Whats ur plan?
1. Admission – 2 large bore canula and…..
2. Expectant Mx up to 37w then do c/s
3. Dexametasone
4. 2 situation that may happen and what to do?
Bleeding and fetal distress – EMERGENT C/s
5. At day of admission, 300ml blood clot , what to do?
- EMERGENT C/s
48 old lady, 1 year amenorrhea, no hx of any surgey, LH 70 IU
1. Dx? – menopause
2. Name 2 long term complication
-osteoperosis
-cancer
3. Tt?
-HRT, combine type
4. Decline HRT, but present 1 year later with vaginal bleeding…what u think?
Endometrial cA
5. 4 additional factors cause this?
Estrogen tt, DM, Obes, PCOS, Nullipara, Estrogen secreting ovarian Ca
6. 2 investigation
- Endometrial samping, U/S, hysteroscopy
Menorrhagia, 48yo, P6 +2, heavy period, take hx
1. Analysis bleeding
2. Prev investigation n tt
3. Gyne hx
4. Medical hx
5. Drug
32 w uneventful preg, normal fetus, c/o watery vaginal discharge
Suggestive pROM
1. How u establish dx?
- Speculum exam-nitrazine test
2. Exam?
-tempt 37 , Pulse 78, uterus equal to date, PROM confirm by speculu,, HVS taken
3. Mention 3 assessment
- u/s
- CTG
- Contraction/not
- CBC + CRP
4. Not contacting, fetus good, u/s normal, crp (-), what to do?
a. Admit
b. Prophylaxis Abs
c. Dexa
d. Fetal maternal monitoring
5. 5 days after admit, temp 37.5, pulse 110, uterus tender, tense, fetal ceplahic, good CTG
Mention 2 steps to do next?
- Change to IV Ab
- Deliver
6. Boshop score 10, wthats next?
-syntocinon infusion
25yp G2P1, deliver by c/s, had cone Biopsy, admit at 7w, IVF pregnancy,mild vag bleed, nild abdominal pain, hemodinamically stable, BHCG 1500, vaginal u/s empty uterus, 2 cm cystic shadowing in adnexia
1. After iv canula n cbc, next step?
2. 20h later clinically stable, BHCG 1000, serum progesterone 10ng, dx?
- Medical
- surgical
3. Tt option?
Ectopic P
4. Few days after receive methotrexate, look pale, pulse 120, bp 90/100,abd pain n tender, mx?
- Recussitate, ivfluid
- Laparotomy
5. 2 risk factors for this ectopic?
- IVF preg
- C/S
35yo, 1st NVD, 10 days ago, presented now as heavy vaginal bleeding after 24h
1. Dx? Secondary PPH
2. Ather possible cause?
- Blood disorder
- ChorioCarcinoma – the do BHCG immediately.
3. u/s : RPOC. Outline the mx of this case
1. admit – 2 large bore, iv line, blood crossmatch….
2. AB in 12 h
3. DnC
4. describe how u do it?(as in skill lab)
5. Complication
- Perforation
- Bleeding
wallahu a'lam. Rabbana Yusahhil...
