This document outlines the components of an obstetric history and examination. It details the information to collect including patient demographics, pregnancy details, past obstetric and medical history, and a physical examination of the patient. The examination involves inspection of the skin and abdomen, measurement of fundal height, identification of fetal parts and position, and assessment of fetal growth, heart rate and movement. Collecting a thorough history and performing a comprehensive physical exam provides important information about the patient's pregnancy and fetal well-being.
Pathophysiology of Normal Labor:
A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
Pathophysiology of Normal Labor:
A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
Obstetrics is the field of medicine which encompasses the care of a woman during pregnancy and childbirth. A good history taking is important to make the pregnancy and childbirth better and avoid any complications.
Taking a good history is very important in making a proper and most appropriate diagnosis.
And it is applicable to all specialties of the medical field.
Obstetrical Ultrasound• Introduced in the late 1950’s ultrasonography is a safe, non- invasive, accurate and cost-effective means to investigate the fetus• Computer generated system that uses sound waves integrated through real time scanners placed in contact with a gel medium to the maternal abdomen• The information from different reflections are reconstructed to provide a continuous picture of the moving fetus on the monitor screen
The first stage of labor and birth occurs when you begin to feel regular contractions, which cause the cervix to open (dilate) and soften, shorten and thin (effacement). This allows the baby to move into the birth canal. The first stage is the longest of the three stages.
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Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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3. OBJECTIVES
• Patient demographics
• Current pregnancy details and complaints
• Past obstetric history
• Past gynecological history
• Past medical and surgical history
• Drug history and allergies
• Family history
• Social history
• Systemic review
• Case summary
4. PATEINT DEMOGRAPHICS
• Name
• Age
• Occupation
• Relationship status
• Booking status
• Gravidity
• Parity
• Last Menstrual Period (LMP)
• Estimated Date of Delivery (EDD)
5. • EDD can be calculated from the LMP using Nagele’s rule
(add 1 year and 7 days to the LMP and subtract 3
months)
• If a cycle is >28 days, the EDD will be later and needs to
be adjusted: the number of days by which the cycle is
longer than 28 days is added to the date calculated in
Nagele’s rule
• If a patient recently stopped combined oral contraceptive
pill, her cycles can be anovulatory and LMP is less useful
6. GRAVIDITYAND PARITY
• Terminology: Gravida x, Para y+z:
• X is the total number of pregnancies (including this one)
• Y is the number of births beyond 24 weeks gestation
• Z is the number of miscarriages or termination of
pregnancies before 24 weeks gestation
• Example: A woman who is pregnant for the 4th time with 1
normal delivery at term, 1 TOP at 9 weeks and 1
miscarriage at 16 weeks would be G4, P1+2
7. CHIEF COMPLAINTS
• What brings you in today?
• Tell me what has been going on?
• What seems to be the problem?
• Common reasons for admission are hypertension, pain,
antepartum heamorrhage, unstable lie and possible
ruptured membranes.
• S.O.C.R.A.T.E.S
8. HISTORY OF PRESENT ILLNESS- 1ST
TRIMESTER
• Planned/Unplanned
• Method of confirmation of pregnancy
• General health (tiredness, malaise and other non specific
symptoms)
• Booking (when, where, how many visits)
• Early booking investigations and result (FBC, Hb
electrophoresis, Blood group and Rh, VDRL, HIV)
• History of vaginal discharge, vaginal bleeding, urinary
problems and flu like symptoms
• Imaging (crown rump length usually between 9-14 weeks)
9. 2nd TRIMESTER
• History of foetal movements
• Symptoms of anemia, miscarriage, ectopic pregnancy
(classic triad- amennorhea, abdominal pain, vaginal
bleeding), vaginal discharge, UTI
• Symptoms of preterm labour, diabetes
• Imaging (head circumference)
• Anomaly scanning? (when, where, why)
• Blood pressure check up
• Changes in weight
10. 3rd TRIMESTER
• Any medication due to HTN, DM, EPILEPSY
• Any labour pains, vaginal discharge, bleeding, urinary
problems
• Hospital stays?
• Any plans of delivery?
11. PAST OBSTETRIC HISTORY
• Details of all previous pregnancies (including miscarriages
and terminations)
• Length of gestation
• Date and place of delivery
• Onset of labour (including details of induction of labour)
• Mode of delivery
• Sex and birth weight
• Fetal and neonatal life
• Clear details of complications or adverse outcomes
(shoulder dystocia, post partum heamorrhage, still birth)
12. GYNAECOLOGICAL HISTORY
• Age of menarche
• Regular/irregular cycles
• LMP, duration of menses, cycle length
• Cervical smear history (last smear, when, where, what
was the result, awareness and follow up plans)
• Methods of contraception
• Difficulties in conceiving?
13. PAST MEDICALAND SURGICAL
HISTORY
• Any illness in childhood or adult life (DM, HTN, Hepatitis,
Psychiatric illnesses, epilepsy)
• Previous hospitalizations (when, where, why, how long)
• Past surgery: Any past surgical procedures, particularly
any abdominal or gynaecological operations as well as
any associated complications or reaction to anaesthesia
15. • Current medications before and after conception
(prescribed, over the counter, herbal)
-Name
-Dosage
-Purpose
-Route
-Frequency
• Pregnancy related medication (folic acid, iron, antiemetic)
• Allergies (what exactly happened)
• Don’t forget vitamins and nutritional supplements
16. FAMILY HISTORY
• Major illness in the immediate family members (DM, HTN,
carcinoma of breast, ovary, colon, endometrium)
• Family history of preeclampsia, eclampsia, DM
• Genetic disorders: sickle cell disease, cystic fibrosis,
chromosomal anomalies
• Previously affected pregnancies
• History of twin
17. SOCIAL HISTORY
• Personal status (smoking and alcohol: amount, duration
and type)
• Occupation
• Educational background
• Socioeconomic status (home conditions, water supply,
sanitation)
• Financial earning of support system
• How many people live in the household
• Domestic violence screening
• Plans for breastfeeding
19. EXAMINATION INTRO
• Introduce yourself and gain consent
• Explain the need and nature of the proposed exam
• Examiner should be accompanied by chaperone
• Respect patient’s privacy at all times
• Patient should be covered at all times and relevant parts
of her anatomy only exposed
• Ensure room is well lit and comfortabe
• Patient should empty bladder before exam
• Should lie supine with pillow under her head and arms at
the side
• Ask for any tenderness before palpation
20. GENERAL
• Measure BMI (Body Mass Index) [weight (kg)/height (m)2]
• Pregnancy complications are increased with BMI <18.5
and >25
• Measure vitals (BP, Temperature, Pulse, Resp rate)
• Blood glucose levels
21. INSPECTION
• Distention
• Fetal movements
• Scars (especially lower segment transverse/longitudinal in
the event of previous C section)
• Skin changes
-Linea nigra
-Striae Gravidarum
-Striae Albicans
-Distended Superficial Veins (increased IVC pressure due
to gravid uterus)
22. LINEA NIGRA
• Dark vertical line appearing on the abdomen from the
pubis to above the umbilicus during pregnancy due to
increase melanocyte stimulating hormone made by the
placenta
23. STRIAE GRAVIDARUM
• Specific scarring of the skin due to sudden weight gain
during pregnancy. Caused by tearing of the dermis and
results in atrophy
24. SYMPHYSIS FUNDAL HEIGHT
• Distance from the symphysis pubis to the uterine fundus
(top of the uterus). The size of the uterus is directly
related to the size of the foetus.
• Technique: palpate down from xiphi-sternum to determine
the fundus and mark that point. A tape measure is then
placed from the mid-point on the uppermost border of the
symphysis pubis, over the curve of the uterus to the
marked highest point and the measurement in cm is
recorded
• The SFH in cm corresponds to the gestation +or- 2cm and
is the best clinical test for detecting ‘small for dates’ fetus
25.
26. FOETAL POLES
• Leopold maneuver 1 also known as the fundal grip
• Both hands placed over the fundus and the contents of
the fundus determined.
-A hard, smooth, round pole indicates the foetal head
- A softer triangular pole continuous with the foetal body is
the foetal buttocks
27.
28. FOETAL LIE
• Leopolds second maneuver or The lateral grip
• Move hands in a downward direction along sides of the
uterus from the fundus. Lie is the relationship between the
longitudinal axis of the foetus and that of the mother.
• Lie is usually longitudinal, hence lying length-wise in the
same direction as mother’s longitudinal axis.
• Other lies are transverse and oblique
• This procedure can also determine which side is the foetal
back (firm, regular surface) and foetal limbs (lumpy and
irregular)
29.
30. PRESENTING PART
• Leopolds third maneuver or Pawlik’s grip
• The thumb and middle fingers of the right hand are placed
wide apart over the suprapubic area to determine the
presenting part.
• The presenting part of the foetus is the lowest part of the
foetus at the inlet of the pelvis.
• Cephalic or breech presentation can be distinguished as
indicated in the previous slide
31.
32. ATTITUDE AND ENGAGEMENT
• Deep pelvic grip
• 1) The attitude of foetal head
Technique: examiner turns around to face patient’s feet and
each hand placed on either side of lower foetal trunk.
Note made as to which hand touches the foetal head
(called the cephalic prominence)
If cephalic prominence is felt on the same side as the back,
this implies the foetal head is extended (abnormal)
If cephalic prominence is felt opposite side of back, head is
well flexed (normal)
33.
34. ENGAGEMENT
• Technique: continue moving hands down and determine
how far around the head you can get.
• Engagement is defined as having the widest transverse
diameter of the foetal head pass through the pelvic inlet
into the true pelvis.
• Divide the head into fifths.
If 5, 4 or 3 fifths can still be palpated, most of the head is
up, hence the widest part has not engaged
If 2, 1 or 0 fifths can be palpated, the widest part has
engagaed into the pelvis
35.
36. ADDITIONAL UTERINE ASSESSMENT
• Liquor volume
Assessment is made of the volume of amniotic fluid
surrounding the foetus
Reduced volme or Oligohydramnios, the foetal parts are
easily felt
Increased volume or Polyhydramnios, there is difficulty in
feeling the foetal parts
Note any foetal movements
37. AUSCULTATION
• Auscultated with Pinard’s foetal stethoscope or doppler
• Best place to listen is over the foetal back, closer to the
cephalic pole
• Normal foetal heart rate is between 110-160 beats per
minute
