Abnormal uterine bleeding (AUB)
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4 malpresentations.warda( 4)-BREECH
- Palpates fetal back anteriorly.
- Applies counter pressure over fetal back to prevent version.
Obstetrician:
- Applies pressure over fetal presenting part (breech) to flex it.
- Applies pressure over fetal back to extend it.
- Applies pressure over fetal head to flex it.
- Rotates fetal presenting part out of pelvis.
- Rotates fetal head into pelvis.
• Version is complete when head engages.
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Postmenopausal bleeding (PMB) refers to bleeding from the genital tract at least one year after menopause. It can indicate underlying malignancy and should be promptly evaluated. The most common causes are atrophic vaginitis (60-80% of cases) and hormone therapy (15-25% of cases). Evaluation of a patient with PMB includes history, exam, endometrial biopsy, and further tests if needed. Common pathologies found are polyps, hyperplasia, and cancer. Treatment depends on diagnosis but may include hormone therapy, surgery, or other options.
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4 malpresentations.warda( 4)-BREECH
- Palpates fetal back anteriorly.
- Applies counter pressure over fetal back to prevent version.
Obstetrician:
- Applies pressure over fetal presenting part (breech) to flex it.
- Applies pressure over fetal back to extend it.
- Applies pressure over fetal head to flex it.
- Rotates fetal presenting part out of pelvis.
- Rotates fetal head into pelvis.
• Version is complete when head engages.
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This document discusses cervical incompetence, also known as cervical insufficiency. It defines cervical incompetence as the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor during the second trimester. The document outlines the causes, diagnosis, and management of cervical incompetence, with a focus on cervical cerclage procedures like the McDonald and Shirodkar techniques. Cervical cerclage involves surgically placing a suture around the cervix to reinforce it and prevent painless dilation during pregnancy.
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Abnormal uterine bleeding includes heavy, prolonged, irregular or abnormal menstrual bleeding that can be caused by various gynecological or systemic conditions. A thorough history, physical exam, blood tests and diagnostic imaging are used to evaluate the bleeding and identify potential causes. Dysfunctional uterine bleeding, one of the most common causes, is attributed to anovulation and unopposed estrogen levels resulting in irregular bleeding. Treatment involves hormonal regimens or surgical procedures if hormones do not control the bleeding.
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This document discusses postmenopausal bleeding, defined as any vaginal bleeding occurring more than 12 months after a woman's last menstrual period. The most common causes are atrophic vaginitis (60-80%), estrogen treatments (15-25%), and cervical or uterine polyps (2-12%). Evaluation involves obtaining a medical history, performing a clinical examination including a cervical smear and pelvic exam, and diagnostic testing such as ultrasound and endometrial biopsy. Treatment depends on the underlying cause, but may include hormone therapy for atrophic vaginitis or polyp removal, and in some cases of hyperplasia or cancer, hysterectomy.
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1. The document discusses abnormal uterine bleeding (AUB) and provides classifications and management guidelines.
2. It describes different types of abnormal bleeding patterns and classifications including the FIGO and PALM-COEIN systems.
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3) The insulin receptors cannot fully respond to insulin so glucose transporters become inactive, glucose cannot enter cells, and hyperglycemia occurs to supply nutrients to support the growth and demands of the fetus and mother.
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3. While bed rest and progesterone supplements are commonly prescribed, there is little evidence that they improve outcomes for TM. Short term reduced activity may relieve stress.
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This document discusses postmenopausal bleeding, defined as any vaginal bleeding occurring more than 12 months after a woman's last menstrual period. The most common causes are atrophic vaginitis (60-80%), estrogen treatments (15-25%), and cervical or uterine polyps (2-12%). Evaluation involves obtaining a medical history, performing a clinical examination including a cervical smear and pelvic exam, and diagnostic testing such as ultrasound and endometrial biopsy. Treatment depends on the underlying cause, but may include hormone therapy for atrophic vaginitis or polyp removal, and in some cases of hyperplasia or cancer, hysterectomy.
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“Difficulty encountered in the delivery of the fetal shoulders after delivery of the head.”
Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%.
An increase in the incidence of shoulder dystocia has been recorded over the last 20 years. Incidence appears to be increasing as birth weights increase.
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1. The document discusses abnormal uterine bleeding (AUB) and provides classifications and management guidelines.
2. It describes different types of abnormal bleeding patterns and classifications including the FIGO and PALM-COEIN systems.
3. Evaluation and treatment recommendations are provided for various causes of AUB including polyps, adenomyosis, leiomyomas, endometrial hyperplasia/cancer, and coagulopathies.
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This document provides guidelines for urinary tract infections (UTIs) during pregnancy. It discusses that UTIs are the most common medical complications of pregnancy and are associated with risks like preterm delivery. It outlines recommendations for screening, diagnosing, and treating asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis during pregnancy. Treatment is recommended for asymptomatic bacteriuria to reduce risks, and symptomatic UTIs should be promptly treated with appropriate antibiotics based on culture and sensitivity testing. Post-treatment cultures are advised to confirm resolution of infections.
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Changes in carbohydrate metabolism during pregnancy include:
1) Increased production of anti-insulin hormones by the placenta like human placental lactogen, cortisol, prolactin, growth hormone, estrogen, and progesterone which cause insulin resistance.
2) This insulin resistance develops in mid-pregnancy and results in low fasting blood sugar but high post-prandial blood sugar as well as low renal threshold for glucose and increased glucose in the urine (glycosuria).
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This document discusses trial of labor after cesarean section (TOLAC) versus elective repeat cesarean section for women with a prior cesarean delivery. It notes that 60-80% of women who attempt TOLAC will have a successful vaginal birth. The risks of TOLAC include uterine rupture, failed trial of labor requiring emergency cesarean, and slightly increased risk of complications for the baby. The risks of elective repeat cesarean include increased risks for placenta problems and complications in future pregnancies. The document provides an overview of the risks, benefits, and success rates to help women decide which option is safest for their individual situation.
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Shoulder dystocia occurs when a baby's shoulders become lodged inside the mother's pelvis during childbirth, making normal vaginal delivery difficult or impossible. The document discusses risk factors for shoulder dystocia such as obesity, gestational diabetes, macrosomia, and previous shoulder dystocia. It recommends calling for help, performing an episiotomy, applying suprapubic pressure, and using maneuvers like McRobert's and Wood's screw to increase the pelvic space or change the baby's position for delivery. Complications can include maternal injuries and fetal nerve injuries, fractures or birth asphyxia if not resolved quickly.
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This document discusses evaluating and managing bad obstetric history (BOH). BOH refers to previous disappointments in childbearing like miscarriages, stillbirths, preterm births, or other complications. A detailed history and medical record review aims to identify recurrent or non-recurrent causes. Common causes include pre-eclampsia, inherited or acquired thrombophilia, parental genetic disorders, anatomical factors, endocrine issues, and infections. Investigation may include screening tests for these conditions. Management focuses on modifying identified risks in the current pregnancy through treatments like low-dose aspirin for pre-eclampsia risk and close monitoring throughout pregnancy. The goal is to learn from past pregnancies to optimize outcomes in future pregnancies.
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The document outlines the risk factors, symptoms, diagnosis, and management of PROM depending on gestational age. Evaluation involves history, physical exam including speculum exam, and tests like nitrazine, ferning, fetal fibronectin, and ultrasound. Management often involves expectant monitoring, antibiotics, corticosteroids, and tocolytics to prolong the pregnancy if it is prior to 34 weeks. The goals are
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