1. Gyne Obs

1. Menstrual Cycle

A regular monthly physiological cycle in females that increases the chances of pregnancy.

1. Phases of Menstrual cycle

There are 3 phases in the menstrual cycle, and to remember them, use the mnemonic

FOL: Follicular, Ovulatory, and Luteal.

The Graafian follicle becomes the ovum under the influence of LH (Luteinizing Hormone), and the corpus luteum then secretes progesterone to support pregnancy.

• FSH (Follicle-Stimulating Hormone), a gonadotropin, acts on the ovary to convert the primary follicle into a secondary follicle.
• LH (Luteinizing Hormone) triggers the ovary to release the ovum (egg).
• After ovulation, the corpus luteum secretes progesterone, which thickens the uterine lining to prepare for pregnancy.

2. Amenorrhea – lack of menses

1. Differential Diagnosis of Amenorrhea

3. Dysmenorrhea : Pain during menstruation

4. Menopause

5. Abnormal/Dysfunctional Uterine Bleeding

There are three parts of uterus;

6. PCOS

1. PCOS Complications

7. Infertility

8. Vaginitis

9. Toxic Shock Syndrome

10. Pelvic inflammatory disease (PID)

11. Pelvic Organ Prolapse

12. Urinary Incontinence

13. Conception

14. Gynecology Cancer

1. Incidence and Mortality

2. Endometrial Cancer

Adnexal masses, weight loss, and an elevated CA 125 are likely indicative of Ovarian Cancer.

3. Meigs’ Syndrome

• Pleural effusion
• Ascites
• Ovarian tumor

2. OBS

The branch of medicine that focuses on the care of the mother during pregnancy and the fetus.

1. Pregnancy

2. Stages of labor

3. Hypertensive Disorders in Pregnancy

1. Treatment

1. Alpha-methyl dopa
2. Labetalol (acts on both alpha and beta receptors)
3. Hydralazine for SBP >180 and DBP >110
4. Magnesium sulfate (MgSO4) for seizures in Eclampsia
5. Calcium gluconate for Magnesium sulfate toxicity

4. HELLP Syndrome:

Remember “HEL” mnemonic

• H: Hemolysis – leading to anemia.
• E: Elevated liver enzymes.
• L: Low platelets.

1.Management:

Emergency C-section delivery is often required, especially after 32 weeks of pregnancy.

5. Ectopic Pregnancy

Implantation of the fertilized egg outside the uterus.

1. Symptoms:

• Amenorrhea (absence of menstruation)
• Lower abdominal pain
• Vaginal spotting

2. Diagnostic Tests:

1. Beta-hCG: Elevated but not as high as normal pregnancy levels.
2. Transvaginal ultrasound: Empty uterus, indicating the fertilized egg is outside the uterus.

3. Treatment:

Methotrexate: Used to dissolve fetal tissue, as it is a folic acid synthesis inhibitor that stops the growth of cells.

6. TORCH Infections

7. Abortion

Loss of fetus before the 20th week of pregnancy. Total Body Weight Loss: 500 mg.

Types of Abortion

• Spontaneous Abortion (miscarriage)
• Medically Induced Abortion

Morning sickness: Less than 13 weeks.

Hyperemesis gravidarum: After 13 weeks with dehydration.

Beta-hCG: Increases significantly in twins or mole.

Treatment (TX):

• Pyridoxine (B6)
• IV fluids + Ondansetron
• Metoclopramide

Diagnosis (Dx): Clinical.

Here are other materials for NLE NRE step 1

8. UTI (Urinary Tract Infection):

• Symptoms: Lumbar pain, dysuria (painful urination), hematuria (blood in urine), and fever.
• E. coli: The most common causative organism for UTI.

Diagnosis (Dx):

• Urine R/E (Routine Examination): To check for signs of infection like leukocytes, nitrites, and blood.
• Urine culture: To identify the causative organism and its antibiotic sensitivity.

Treatment (Tx):

• Ceftazidime (Cefta): A broad-spectrum antibiotic commonly used for UTI, particularly when the organism is E. coli.

9. Shoulder Dystocia:

Occurs during birth when the shoulder gets stuck behind the mother’s pelvic bone, leading to a prolonged second stage of labor.

Management:

1. McRobert’s maneuver.
2. Suprapubic pressure.
3. Wood’s screw maneuver.
4. Episiotomy

Complications:

1. Brachial Plexus Injury.
2. Horner’s Syndrome.

10. Preterm Labour

Occurs when labor starts between 10 to 36 weeks of pregnancy.

Common Cause of Neonatal Mortality

It is a leading cause of neonatal death due to complications like respiratory distress syndrome and organ immaturity.

Management:

Hydration & Bed Rest: Aims to reduce contractions and promote fetal well-being.

Tocolytic Therapy:

• Beta-2 Agonists (e.g., Terbutaline): To relax the uterus and delay labor.
• Calcium Channel Blockers (e.g., Nifedipine): Used to prevent uterine contractions.
• Magnesium Sulfate (MgSO4): For uterine relaxation and fetal neuroprotection if the pregnancy is very preterm.
• Betamethasone: A corticosteroid to enhance fetal lung maturity and reduce respiratory issues.
• Prostaglandins: Used in some cases to help induce labor or soften the cervix.
• Penicillin: Administered to prevent Group B Streptococcus (GBS) infection.

11. Fetal Malpresentation

Any position other than the head-first (vertex) presentation.

Breech Position

The fetal buttocks or feet are positioned to come out first during labor.

1. Frank Breech:
   • Thighs are flexed, and knees are extended.
2. Footling Breech:
   • One or both legs are extended.
3. Complete Breech:
   • Both thighs and knees are flexed.

1. Management (Tx):

C-section: Typically the preferred method for breech deliveries to prevent complications.

2. Indications for C-section:

• Previous C-section History: If there’s a history of a previous C-section, a repeat cesarean might be recommended.
• HIV: To reduce the risk of transmission to the baby.
• Adverse Conditions: Such as HPV, cancer, or other contraindications for vaginal birth.
• Decreased Heart Rate: Suggesting fetal distress during descent.
• Fetal Demise: If the fetus has died in utero.
• Umbilical Cord Distress: If the cord is compressed, affecting fetal oxygenation.

12. Rh Isoimmunization

Occurs when an Rh-negative mother produces antibodies against Rh-positive fetal red blood cells.

Scenarios:

1. Mother Rh- and Fetus Rh+

Risk: Rh incompatibility may lead to the mother’s immune system attacking the fetus’s red blood cells, causing hemolytic disease of the newborn (HDN).

Prevention: Rh immunoglobulin (RhoGAM) is given to the mother to prevent the formation of antibodies.

2. Mother Rh- and Fetus Rh-

No risk: There is no Rh incompatibility as both the mother and fetus are Rh-negative, so no antibodies are formed.

3. Mother Rh- and Husband Rh-

No risk: If both parents are Rh-negative, the fetus will also be Rh-negative, eliminating the risk of Rh isoimmunization.

First Pregnancy

• Mother Rh-negative, baby Rh-positive: The mother produces IgM antibodies initially, which don’t cross the placenta. After 7 months, IgG antibodies are produced, but the first child is usually safe.

Second Pregnancy

• Rh-negative mother, Rh-positive fetus: The IgG antibodies cross the placenta, causing hemolytic disease of the newborn, which can lead to fetal death.

Prevention of Rh Isoimmunization

Mother Rh-negative, Fetus Rh-positive:

• Give Rh immunoglobulin (RhoGAM) at 28 weeks of pregnancy to prevent the formation of antibodies.
• If the baby is born Rh-positive, administer RhoGAM within 72 hours after delivery to prevent sensitization.

13. Quad Screen Test

Check chromosomal abnormalities between  18 – 22 weeks.