obg updates

8/18/2019 Obg Updates

1/16

OBG update 1ADIANAFDA approved method of permanent contraception.First a 60 sec rad iofrequency thermal injury is d one to the intramural portion of fallopiantube.Then a silicone elastomer is i nserted into tubal lumen.Aftwr 3 m onths h sg is r equired for conrming c omplete occlusion.

OBG UPDATE 2For all of you cardiac o utput in pregnancy in detail at each week. So that you dont getconfused ever. Postpartum greater than late labor and s econd s tage greater than 2 8-32weeks.


2/16

OBG UPDATE 3Return of hcg to undetectable levels after evacuation in molar pregnancy

Update 4 O BGLambda si gn or twin p eak signSeen in dichorionic t wins


3/16

Update 5 O BGTODAY VAGINAL SPONGE.when in position the sponge dimple apposes t he cervix su rface, and the ribbon loop facesoutward to allow easy h ooking with a nger for removal.


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5/16

Update 6 O BGPrimordial germ ells a re derivatives o f Epiblast Ref: Pg. 13, Langman Embryology (Ed 11th),Pg. 186, Gray’s Anatomy (Ed 4 0th)Primordial germ (PGCs) cells ha ve b een isolated from theepiblast at the posterior end of primitive streak i n 2nd week.Germ layers form in the 3rd weekby the process o f gastrulation.Hence, PGCs ca nnot be considered as a derivative of anyembryonic g erm layers.Though some investigators co nsider epiblast as p rimitive ectoderm,hence, ectoderm can be a choice as a nswer, if epiblast was n ot among the options.Earlier itwas b elieved that the primordial germ cells a re derived from the endoderm of yolk s ac w all,but now it is established that they are derivative of the epiblast cells, they migrate through theyolk sa c w all, and the mesentery o f hindgut to reach the genital ridge.

OBGY update 7williams t able showing amniotic ffluid levelssecond g raph also from williams sh owing the steady d ecline in amniotic u id afyer 28-32weeks by 3 different workers


6/16

UPDATE 9 OBGYFor those w ho just want to m ug up guides a nd challenge what we teach in class.The rst para is pa ge 404 a nd second para p age 4 07 leon sp eroff. The rst change a tpuberty is growth spurt!!!

UPDATE 10 OBGYA common mistake to the question - predominant estrogen produced b y p lacenta at term.

invariably y ou all answer estriol which is w rong. correct answer is e stradiol.


7/16

UPDATE 11 OBGYgonadal dysgenesis an d a mbiguous ge nitalia h as b een o ne of the repeated topics i n AIIMS

exam. Turners syn drome is t he rst of these i am updating about.


8/16

UPDATE 12 OBGYSecond important topic from sexual differentiation.

please note this i s h ow we dene mullerian agenesis o r rokitansky syndrome- characterizedby absence of vagina absent or hypoplastic u terus a nd normal or hypoplastic f allopian tube.whereas i n AIS there is a blind ending or short vagina.


9/16


10/16

Pelvic s ide wallearly st age 50-55Gyadvanced st age 5 5-60Gy

Absolute d ose for rectum less t han 7 5Gy an d for bladder less t han 80Gy

UPDATE 16 OBGYRh negative p regnancyhigh yield points

1) most common hemolytic di sease i n n ewborn is A,B incompatability

2) C,D,E antigens a re located on short arm of chromosome 1

3 ) lewis syst em does not cause hemolysis

4) immune hydrops - uid collects i n thorax a bdominal cavity a nd skin

5) mirror syndrome when rh negative se nsitized mother develops p re e clampsia. she

resembles t he h ydropic ba by.6)ICT critical titre is 1:16

7) MCA peak systolic vel ocity more t han 1 .5MoM cirresponds t o m od to s evere fetal anemia

8) on liley curve zone 2 upper half indicates h b between 8-10.9lower half hb is b etween 11-13.9

9) on liley cu rve zo ne 3 m eans h b less t han 8 gm %

10) intrauterine transfusion is d one when fetal hematocrit less than 30%

11) 300micro gm od anti d is g iven to the mother within 72 hrs o f delivery i f fetus i s rh p ositive.

12) dose of anti d after rts t rimester abortion is 5 0 micogramand after 12 weeks i t is 3 00mcg

13) 300mcg anti d protects a gainst 30ml fetal blood and 15ml fetal rbc

14) dose of anti d is c alculated by KB test based on that fetal red cells a re resistant to aciddenturation

15) maternal to fetal hge resulting in isoimmunization is c alled as g randmother theory.

UPDATE 17 OBGYDenition of precipitate labour for some of you who read guides. page 470 williams 2 3rd

edition.

UPDATE 18 OBGYPOST MENOPAUSAL HORMONE THERAPY

CVS both E and E+P are protective for cvs. The protective effect is m ore with E alone.But even then it is n ot given for primary p revention of CAD.

Postmenopausal HRT increases r isk o f VTE. But most cases o ccur in rst 2 yrs o fexposure a nd in women more than 70yrs and who a re obese.


11/16

Breat cancer. current postmenopausal HRT increases r isk b reast cancer. the risk is m orewith E+P than E alone. But the cancer that occur after hrt are seen to be betterdifferentiated.

Endometrial cancer. E alone o r umopposed E is a risk f actor once progesterone is a dded

then it does n ot increase risk of endometrial cancer.The minimum no of days a t which progesterone has pr otective e ffect is 12 -14 days in amonth.

ovarian cancer. risk i s i ncreased with both E alone and E+ P

colorectal cancer. risk is r educed with both E and E + P

diabetes mellitus Both E and E+P improve gluocse tolerance

dementia- both E and E+P increase the risk o f dementiain women older than 65 yrs

HRT reduces the prevelence and severity o f osteoarthritis at hip joint. But it is n ot rst linetherapy for same.

UPDATE 19 OBGYIOCs f or various co nditions

broid - USG

tubal payency- HSG

Mullerian anomalies - MRI

Endometriosis - Laproscopy

post coital bleeding - PAPS

post menopausal bleeding -endometrial biopsy

pid - USG

adenexal mass - USG

amenorrhoea - hormonal asessment

molar - USG

Ectopic - TVS

ovulation - f ollicular m onitoring

hirsutism with menstrual irregularity- - serum testosteroneAUB USG

Adenomyosis - MRI

ovarian reserve - FSH

VVF - Cystoscopy

UPDATE 20 OBGYRisK of progression and regression in CIN Lesions

10% of LSIL progress t o HSIL

10% of HSIL Progress to invasive ca rcinoma.


12/16

average time taken by CIN 3 to progress t o malignancy i s 5 -10 yrs

UPDATE 21 OBGYCOLPOSCOPE AIPG update( recent question)invented by H inselmann in 1 925

it has a focal length of 30cmcolposcope has a magnication 9f 10-30 times

colpomicroscope has a magnication of 100-300 times

it has a green lter


13/16

UPDATE 22 OBGYPUBERTY

Puberty is m arked by b eginning o f nocturnal pulse sectetion of GnRH which c auses increasein LH Hormone p ulse a mplitude

Factors w hich promote GnRH pulsatile release at puberty a re1) decrease in GABA2) decrease in neuropepetide Y3) increase in glutamate4) increase in kisspeptin5) increase in leptin( which is r elated to body w eight)

increase in GnRH causes i ncrease in basal estradiol and Inhibin B while inhibin A lwvelsremain low

GnRH is released fron arcuate n ucleus in m edial hypothalamus

neurons t hat synthesize GnRH originate from olfactory p lacode

hypothalamic piuitary venous syst em development in fetus be gins b y 9- 10 weeks a ndcompleted b y 19 - 20 weeks of pog

pituitary LH FSH secretion in fetus be gins a t 12 weeks a nd peaks at 20 weeks o f pog.

UPDATE 23 OBGYThe e pididymis i s d ivided into following s egments, the initial segement the caput where t hesperm begin their process o f maturation, the corpus w here maturation continues a nd caudathe site of nal matutation and storage.SO MATURATION OF SPERM OCCURS IN EPIDIDYMIS not female genital tract.page 2 44 leon spe roff.

UPDATE 24 OBGYPersona consists o f a small hand held Monitor,which is a mini-computer, and disposable urineTest Sticks.

You sample your morning urine on the Test Stick ( for 16 days t he rst month, and for 8 days i n

subsequent months).


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The Test Stick collects 2 hormones i n the urine and converts t heir levels i nto a form that canbe r ead b y the Monitor.

Then you insert the Test Stick into a special slot on the Monitor.

The Monitor reads a nd analyzes t he Test Stick, it learns a bout your unique cycle prole, and it

displays birth control and cycle advice every d ay.The Monitor t ells yo u when you need to test, when you can have sex (Infertile days), whenyou s hould abstain from sex o r use a barrier method ( Fertile days), and when yo u're about tostart your menstrual period.

The Monitor displays:

Ayellow light when test is n eeded

A red light on fertile days

A green light for infertile days

UPDATE 25 OBGYMAGNESIUM SULPHATE

1) is not given to treat hypertension , it is given as anticonvulsant2) anticonvulsant action is o n cerebral cortex3)main action is b lockade of NMDA receptors i n brain4)if not controlled w ith mgso4 then supplementary m edication is a mobarbital or thiopentalgiven iv slowly5)at the dose given for eclampsia it does n ot inhibit uterine contractions. levels n eeded toinhibit uterine contractions is 8-10 meq/l6) it also has n europrotective fetal effects i n preterm babies.

UPDATE 26 OBGYCLASP TRIAL, ABSTRACT

In o ur multicentre st udy 93 64 women were r andomly ass igned 60 mg a spirin d aily ormatching placebo74% were entered for pr ophylaxis o f pre-eclampsia, 12% for prophylaxis o f IUGR, 12% fortreatment of pre-eclampsia, and 3% for treatment of IUGR.

Overall, the use of aspirin was a ssociated with a reduction of only 1 2% in the incidence ofproteinuric p re-eclampsia, which was n ot signicant. Nor was t here any s ignicant effect onthe incidence of IUGR or of stillbirth and neonatal death.

Aspirin did, however, signicantly r educe the likelihood of preterm delivery ( 19.7% aspirin vs22.2% control; absolute reduction of 2.5 [SD 0.9] per 10 0 women treated; 2p = 0.003). Therewas a signicant trend (p = 0.004) towards p rogressively g reater reductions i n proteinuric p re-eclampsia t he more p reterm the d elivery.

Aspirin was n ot associated with a signicant increase in placental haemorrhages o r inbleeding during preparation for epidural anaesthesia, but there was a slight increase in use ofblood transfusion after delivery.Low-dose aspirin was g enerally sa fe for the fetus a nd newborn infant, with no evidence of anincrea sed likelihood of bleeding.


15/16

Our ndings d o not support routine prophylactic o r therapeutic a dministration of antiplatelettherapy in pregnancy t o all women at increased risk o f pre-eclampsia or IUGR. Low-doseaspirin may be j ustied in women judged t o b e especially liable to e arly-onset pre-eclampsiasevere enough to need very p reterm delivery. In such women it seems a ppropriate to startlow-dose aspirin prophylactically early i n the second trimester.

UPDATE 27 OBGYPCOD AND METABOLIC SYNDROMEInsulin lowering agents m ay b e g iven w hen t hese criteria a re p resent1) waist > 35 inches2) TG > 150mg/dl3) HDL < 50m g/dl4) BP> 130/855) Fasting glucose 110-125mg/dl6) 2hr gtt 140-199mg/dl

UPDATE 28 OBGYSOFT SIGNS OF DOWNS SYNDROME SEEN IN 2ND TRIMESTER USG

UPDATE 29 OBGYDOWNS C9CONTINUED

VALUES OF MARKERS USEDFirst trimester serum screening done from 11-14 weeks

second trimester serum screening done betweeb 15 -20 weeks


16/16

hCG 2 MoMPAPPA 0.4 MoMAFP 0.7 MoMunconjugated e striol 0.8 MoMInhibin A 1.8 MoMcut off for NT IS 3.5mm

Amniocentesis don e b etween 15-20 weeks

CVS done between 10-13 weeks

NT Done between 11 - 13+6weeks

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