Obstetrics Important points

• 1. Antenatal care is designed to support normal physiological process & to detect early signs of complications.
• 2. The median duration of pregnancy is 280 days (40 weeks)
• 3. EDD is calculated by taking the date of LMP, counting forward by 9 months & adding 7 days.
• 4. Pregnancy calculating wheels may give dates that are a day or two different from manual method.
• 5. Ultrasound scan done in late first trimester or early 2nd trimester before 20 weeks, purposes of this scan are to establish dates, to ensure that pregnancy is ongoing & to determine number of fetuses.
• 6. Ultrasound defined dates are more accurate than those based on a certain LMP.
• 7. National institute of health & care excellence (NICE) recommend that pregnancy dates are set only by US using crown rump measurement b/w 10 weeks 0 days & 13 weeks 6 days, and head circumference from 14 to 20 weeks.
• 8. Accurate dating reduces the risk of premature elective deliveries, induction of labor for postmature pregnancies & elective C-Section.
• 9. Maternal mortality is higher amongst older women.
• 10. Smoking causes a reduction in birth weight in a dose dependent way, also increase risk of miscarriage, stillbirth, neonatal death. 
• 11. Alcohol is not harmful in small amounts in pregnancy (less than one drink per day), binge drinking is harmful & can lead to a constellation of feature in a baby called fetal alcohol syndrome.
• 12. Cocaine & crack cocaine are the most harmful of the recreational drugs taken.
• 13. Past history that impact on future pregnancies = recurrent miscarriage, preterm delivery, early onset preeclampsia, abruption, congenital anomaly, macrosomic baby, FGR, Unexplained stillbirth.
• 14. Gravida = Number of time she previously concieved regardless of how they ended plus current pregnancy.
• 15. Parity = Number of live births at any gestation or stillbirths after 24 weeks. (In terms of parity, twins count as 2)
• 16. Women will PCOS has a higher risk of development of GDM.
• 17. Women who concieve with an intrauterine device still in situ, carries an increase in the risk of miscarriage.
• 18. Previous history of PID increase the risk of ectopic pregnancy.
• 19. Cervical smear for cervical cancer cam be taken in first trimester.
• 20. knife cone biopsy is associated with increased risk for cervical incompetence (weakness) & stenosis (leading to preterm delivery & dystocia in labor).
• 21. Increase Risk of preterm birth is very small with large loop excision of transformation zone (LLETZ).
• 22. Previous ectopic pregnancy increase the risk of recurrence to 1 in 10.
• 23. Antiphospholipid syndrome increase the risk of further pregnancy loss, FGR, pre eclampsia.
• 24. Multiple previous first trimester miscarriage increase the risk of preterm delivery, possibly secondary to cervical weakness.
• 25. Donor egg or sperm use is associated with increased risk of pre eclampsia.
• 26. Legally, you should not write down in notes that a pregnancy is concieved by in vitro fertilization (IVF) or donor egg or sperm unless you have written permission from patients.
• 27. Surgery has been performed for crohn's disease may continue to be a problem during pregnancy.
• 28. Women who has epilepsy they must continue their medication during pregnancy.
• 29. Women with a BMI <20 are at higher risk of fetal growth restriction & increase perinatal mortality, while in obese women (BMI>30) the risk of GDM & HTN are increased.
• 30. HTN diagnosed for first time in early pregnancy (bp > 140/90 mmHg on two separate occasions at least 4 hours apart). 
• 31. Measure bp with women seated or semi recumbent position.
• 32. Convention is to use korotkoff V (disappearance of sounds) more reproducible tgan korotkoff IV.
• 33. Identification & early treatment of asymptomatic bacteriuria reduces the risk of pyelonephritis.
• 34. Acute pyelonephritis increase the risk of pregnancy loss, premature labor & associated with maternal mortality.
• 35. In late pregnancy, women should never lie completely flat, semi prone position or a left lateral tilt will avoid aortocaval compression.
• 36. Striae gravidarum = stretch marks
• 37. linea nigra = faint brown line running from umbilicus to symphysis pubis.
• 38. Purpose of palpation of pregnant women = number of babies, size of baby, lie of baby, presentation of baby or whether the baby is engaged.
• 39. SFH should be measured & recorded at each antenatal visit from 24th week gestation.
• 40. Large SFH may be due to multiple pregnancy, macrosomia, polyhydramnios.
• 41. Small SFH may be due to FGR, oligohydramnios.
• 42. If you can feel one or two fetal poles it is likely to be a singleton pregnancy, if you can feel 3 or 4 a twin pregnancy is likely.
• 43. After 36 weeks, if pole over pelvis the lie is longitudinal, when pole doesnt lie over pelvis but just to one side it is oblique lie, when pole lies directly across the abdomen it is transverse lie.
• 44. Presentation can be cephalic or breech.
• 45. If whole head is palpable & easily movable, the head is likely to be free (5/5th palpable). when head is no longer movable, it has engaged & only 1/5th or 2/5th will be palpable.
• 46. By using a pinard stethoscope, position it over the fetal shoulder to hear the heartbeat.
• 47. If you cannot detect a heart beat with pinard, use hand held doppler device.
• 48. Contraindications to digital examination in pregnancy = known placenta previa, vaginal bleeding, presenting part unengaged, prelabour rupture of membranes (inc risk of ascending infection)
• 1. Perinatal death are inversely proportional to number of antenatal visits.
• 2. Perinatal mortality rate is lowest for those women who attention antenatal visit between 10-24 times in pregnancy.
• 3. Parentcraft education is term often used to describe formal group discussion of issues relating to pregnancy, labour, delivery & care of newborn.
• 4. Institute of medicine guideliness on recommended weight increase in pregnancy, for normal weight women (total weight gain in pregnancy : 11-16 kg), for overweight women (7-11 kg), for obese (5-9 kg).
• 5. Royal college of obs & gynae (RCOG) Provides dietry advice for optimal weight control in pregnancy.
• 6. Aerobic & strength conditioning exercise in pregnancy is considered safe & beneficial.
• 7. Contact sports should be avoided in pregnancy
• 8. Pelvic floor exercises during pregnancy & immediately after birth may reduce the risk of urinary & faecal incontinence in future.
• 9. RCOG provides modified heart rate target zones for exercise in pregnancy based upon age : women <20y (140-155bpm), 20-29y (135-150 bpm), 30-39y (130-145 bpm), >40y (125-140 bpm).
• 10. WHO recommends initiation of breast feeding within an hour of birth.
• 11. Advantages of home birth = familiar surroundings, no interruption of labour to go to hospital, no separation from other children or partner, continuity of care, reduced inteventions.
• 12. Disadvantages of home birth = poor perinatal outcome, limited analgesic options (no epidurals)
• 13. Advantages of midwifery units or birth centres = continuity of care, fewer interventions, convenience of location.
• 14. Disadvantages of midwifery units or birth centres = transfer out to a hospital, limit access to analgesic options.
• 15. Advantages of hospital birth center = doctors, obstetricians, anaesthetics, neonatologists available.
• 16. Disadvantages of hospital birth center = lack of continuity of care, greater interventions.
• 17. Most common anemia in pregnancy = iron deficiency anemia.
• 18. Reference range of Hb in pregnancy = 10-12g/dl.
• 19. To determjne the patient's blood type & Rh = Direct coombs test 
• 20. To determine the presence of atypical RBS antibodies = Indirect coombs test
• 21. Prophylactic administration of Anti -D for Rh negative mother = At 28th week & at 34th week.
• 22. Rubella vaccination is contraindicated in pregnancy.
• 23. Pregnancy should be avoided for the 3 months after rubella vaccinations 
• 24. Screening tet for HIV = ELISA Test
• 25. Definitive test for HIV = Western blot test
• 26. Vertical transmission of HIV is reduced to less than 5% by use of antiretroviral therapy, elective C Section, avoidance of breastfeeding.
• 27. Screening tests for Syphilis = VDRL & RPR.
• 28. Definitive tests for syphilis = MHA-TP & FTA.
• 29. Screening test for gestational diabetes = 1-hour 50-g OGTT at 28 weeks.
• 30. Definitive test for gestational Diabetes = 3- hour 100-g OGTT at 28 weeks.
• 31. Nuchal translucency scan done at 11-13 weeks for down's syndrome.
• 32. Serum screening done at 15-19 weeks for down syndrome.
• 33. Maternal serum AFP is done at 15-19 weeks for neural tube defects.
• 34. Anomaly US scan is done at 19-22 weeks for structural & congenital anomalies.
• 35. Minimum number of antenatal visits recommended by RCOG is FIVE  occuring at 12 weeks, 20 weeks, 28-32 weeks, 36 weeks, 40-41 weeks.
• 36. Crown rump length is used to calculate gestation age before 12 weeks.
• 37. Biparietal diameter is used to calculate gestation age between 12-20 weeks.
• 38. Optimal gestation at which to determine chorionicity = 9-10 weeks
• 39. Key indicators for Dichorionic = thicker inter twin separating membrane & lambda sign.
• 40. key indicators for Monochorionic = thin inter twin separating membrane & absence of lambda sign.
• 41. Nuchal translucency assess the amount of fluid behind the neck of fetus. If it is large (causes : down's syndrome, trisomy 18, trisomy 13, cardiac defects)
• 42. Mid pregnancy scan is performed at 18-22 weeks to detect fetal structural & chromosomal abnormalities.
• 43. Fetal growth can be assessed by measurement of biparietal diameter, head circumference, abdominal circumference, femur length.
• 44. Abdominal circumference is the most important measurement in assessing fetal size, growth & weight.
• 45. fetal well being can be assessed by amniotic fluid index, cardiotocograph, biophysical profile, umbilical artery doppler.
• 46. Biophysical profile consist of breathing movement, gross body movements, fetal tone, reactive fetal heart rate, qualitative amniotic fluid.
• 47. Biophysical score of 8-10 (normal), score of 4-6 (worrisome), score of 0-2 (highly predictive of fetal hypoxia).
• 48. CTG is an indirect method of monitoring heart rate. It has baseline heart rate, baseline variability, acceleration & deceleration.
• 49. Normal baseline heart rate (110-150 bpm), normal baseline variability (10-25 bpm), normal acceletations (2 in 20 mins).
• 50. Invasive diagnostic tests in pregnancy are amniocentesis, chorionic villus sampling, cordocentesis.
• 51. Amniocentesis = aspiration of amniotc fluid (sample : fetal fibroblasts) undertaken after 15 weeks gestation.
• 52. Chorionic villus sampling = aspiration of trophoblastic cells (sample : trophoblasts cells) undertaken after 10 weeks gestation.
• 53. Cordocentesis = performed after 20 weeks when umbilical cord vessels are large enought to enter safely. (Sample : fetal WBC)
• 54. Neural tube defects consist of anencephaly, encephalocele, spina bifida (spina bifida occulta, myelomeningocele, meningocele).
• 55. Anencephaly = frog like appearance in US scan
• 56. Spina bifida = lemon shaped skull, banana sign in US scan.
• 57. Neural tube defects can be prevented by oral folate supplementation.
• 58. Most common congenital anomalies = congenital heart defects.
• 59. Most common congenital cause of GI obstruction = duodenal atresia.
• 60. Duodenal atresia = double bubble sign & polyhydramnios in US Scan.
• 61. Esophageal atresia = absence of stomach bubble & poluhydramnios in US scan.
• 62. Typical appearance of Down's syndfome = flat facies, epicanthic folds, single palmar crease.
• 63. Fragile X syndrome is sex linked disorder, most common inherited cause of mental retardation (FMR1 gene is hyoermethylated), diagnosis by PCR or southern analysis.
• 64. Cystic fibrosis is autosomal recessive disorder, due to mutation of cystic fibrosis gene on chromosome number 7, diagnosis by history & Chorionic villus sampling.
• 65. Sickle cell disease = autosomal recessive disorder, characterized by abnormal HbS which is due to defect caused by valine substitution for glutamic acid at position 6 of beta chain
• 66. Thalassemia = autosomal recessive disorder, impaired production of globin chains, prenatal diagnosis by Chorionic villus sampling.
• 67. Physiological changes during pregnancy = Fluid retention,increase blood flow,  hemodilution (physiologic anemia), hypercoagulability, increase heart rate, loud murmur, decrease blood pressure in first trimester, diaphragmatic breathing, PO2 decreases, PO2 increases, enlarged kidney, dilated ureters, heartburn, constipation, linea nigra, melasma, pigmented nevi, enlarged uterus, swollen soft & dilated cervix, high acidity of vagina, enlarged pituitary gland thyroid gland, relative insulin resistance, increase prolactin.
• 68. Most common type of twins = Dizygotic twins (non identical or fraternal twins).
• 69. All monochorionic pregnancies are monozygotic, but not all dichorionic pregnancies are dizygotic. 
• 70. Monozygotic twins = results from division of a single already developing embryo into two embryos (identical & always the same sex).
• 71. If embryo division occurs within 3 days (dichorionic, diamniotic), if occur b/w 4-7 days (monochorionic, diamniotic), if occurs b/w 8/12 days (monochorionic, monoamniotic), if occurs after 12 days (conjoined "Siamese" twins).
• 72. Incidence of monozygotic twins = 1 in 250
• 73. Differential diagnosis of monozygotic twins = polyhydramnios, uterine fibroids, urinary retention, ovarian masses.
• 74. Complication of monochorionic pregnancy = twin to twin transfusion syndrome
• 75. Maternal complications of multiple pregnancies = hyperemesis gravidarum, anemia, pre eclampsia, gestational diabetes, polyhydramnios, placenta previa, APH, PPH, operative delivery.
• 76. Serial growth scan is done at 28, 32 & 36 weeks for dichorionic twins.
• 77. Most common presentation in twin pregnancy = cephalic-cephalic (60%)
• 78. indications for elective C section in twin pregnancy = malpresentation of 1st twin, 2nd twin larger than 1st, growth restriction in one or both twins, monoamniotic twins 
• 79. Ideal criteria of vaginal delivery for twin = spontaneous onset of labour, cephalic presentation of twin 1, twin 1 larger than twin 2, dichorionic pregnancy.
• 80. 2nd twin is usually delivered within 15 minutes of the 1st twin.
• 81. If the fetus is transverse in vertex-nonvertex delivery, external cephalic version can be successful in more than 70% of cases. If it is unsuccessful, internal podalic version can be undertaken.
• 82. Cardiac disease is the 3rd most common non-obstetric cause of maternal death after HTN & Pulmonary embolism.
• 83. Most common rheumatic heart disease = mitral stenosis
• 84. Keep 2nd stage of labour short by elective forceps or ventous delivery in pregnant lady with cardiac disease.
• 85. Ergometrine (vasoconstrictor) should be avoided in pregnancy with cardiac disease.
• 86. Eisenmenger's syndrome is characterized by pulmonary hypertension & bidirectional shunt.
• 87. Human placental lactogens & cortisol increase insulin resistance.
• 88. Triple marker screen at 16-18 weeks to assess for neural tube defects .
• 89. Lung immaturity can be assess by amniotic fluid (lecithin to sphingomyelin ratio of 2.5 & presence of phosphatidyl glycerol)
• 90. Full glucose tolerance test should be performed at 6 weeks following delivery to ensure that the diabetes has resolved.
• 91. Carbimazole & propylthiouracil are the first line therapy for hyperthyroidism in pregnancy.
• 92. Thyroidectomy can be ideally performed in 2nd trimester.
• 93. Radioactive iodine is contraindicated in pregnancy & breast feeding.
• 94. Fetus requires maternal T4 for normal brain development before 12 weeks, inadequate re placement may lead to reduced IQ in offspring.
• 95. For antenatal treatment of SLE, Steroids & azathioprine may be given safely.
• 96. NSAIDS should be avoided in pregnancy.
• 97. Anti-cardiolipin antibody & lupus anticoagulant present in antiphospholipid antibody syndrome.
• 98. Regional anesthesia is contraindicated in the presence of thrombocytopenia.
• 99. Obstetric cholestasis is associated with sudden intrauterine death, mostly at term.
• 100. Tea decreases iron absorption.
• 101. First indicator to assess response by treatment of anemia = reticulocyte count
• 102. Vaginal delivery & epidural anesthesia is preferres in patient with sickle cell disease.
• 103. Alpha thalassemia major may cause fetal hydrops & preeclampsia.
• 104. parenteral iron should be avoided in patient with thalassemia.
• 105. Thalassemia major can be detected in 1st trimester by CVS, While in 2nd trimester by cordocentesis.
• 106. Pregnancy induced hypertension refers to bp >140/90 mmHg after 20 weeks gestation.
• 107. ACE inhibitors & diuretics are contraindicated during pregnancy.
• 108. Drug of choice for HTN in pregnancy = Methyldopa
• 109. Alternative antihypertensive = labetolol (alpha-beta blockers) & Nifedipine (calcium channel blocker).
• 110. aim of antihypertensive medication is to maintain bp <160/100 mmHg.
• 111. Administration of IV MgSO4 is to prevent convulsions.
• 112. IV Hydralazine or labetolol is to keep diastolic bp b/w 90-100 mmHg.
• 113. Pre eclampsia refers to bp >140/90 mmHg, presence of >300mg protein in 24-hour urine collection at 20th week of gestation which would be resovled by 6th week following delivery.
• 114. Mild preeclampsia (bp <160/90 mmHg) & severe preeclampsia (bp>160/90 mmHg).
• 115. Definitive care of preeclampsia is delivery of fetus & placenta.
• 116. Mode of delivery before term is usually be Cesarean section.
• 117. Eclampsia refers to grand mal convulsions with established preeclampsia in the absence of any metabolic or neurological cause.
• 118. Overdose of MgSO4 is associated with respiratory depression & cardiac arrest which can be reversed with Calcium gluconate.
• 119.HELLP Syndrome is a combination of hemolysis, elevated liver enzymes & low platelets 
• 120. Most common type of pelvis = Gynecoid pelvis.
• 121. Typical male pelvis = android pelvis
• 122. Anterior frontanelle of fetal skull is diamond shaped & it is at the junction b/w saggital, frontal & coronal sutures.
• 123. Posterior frontanelle is a triangular shaped & it is at junction of sagittal & lambdoidal sutures.
• 124. Most common lie of fetus = longitudinal lie
• 125. most common presentation of fetus = Cephalic
• 126. Most common position = occipito anterior
• 127. Labour is defined as process of painful regular uterine contractions bring about effacement & dilatation of cervix & descent of the presenting part, leading to expulsion of fetus & placenta.
• 128. Stages of labour = Stage 1 (from onset of labour to full cervical dilatation "10cm"), stage 2 (delivery of fetus), stage 3 (delivery of placenta).
• 129. Mechanism of labour = Engagement, Descent, flexion, internal rotation, extension, restitution, external rotation, expulsion.
• 130. On vaginal examination, when no cervix can be felt this means the cervix is fully dilated.
• 131. Signs of separation of placenta = lengthening of cord, small gush of blood, rising of uterine fundus, fundus become hard & globular.
• 132. Controlled cord traction method is used to separate placenta.
• 133. Poor Progress in labour is dependent on 3Ps (powers, passenger, passages).
• 134. Inefficient uterine contraction is the most common cause of poor progress in labour.
• 135. Cervical dystocia occurs because of severe scarring caused by previous cone biopsy.
• 136. Secondary uterine inertia is a common cause of second stage delay. (Associated with maternal dehydration & ketosis)
• 137. Partogram is a graphical record of labour.
• 138. Prolonged latent phase is diagnosed by cervical dilatation is less than 3cm.
• 139. Most common malpresentation = breech presentation
• 140. In face presentation, if chin is mento-anterior (vaginal delivery), if chin is antero posterior (C-Section).
• 141. Methods of induction of labour = Amniotomy, prostaglandin (PGE2), Oxytocin infusion.
• 142. Types of forceps = low cavity forceps (Wrigley's), mid cavity rotational forceps (kjelland's), mid cavity non rotational forceps (simpson's).
• 143. Prerequisites for forceps delivery = 
• F : fully dilated cerivx
• O : no obstruction
• R : ruptured membranes
• C : consent, catheterization.
• E : Explain procedure, epidural anesthesia, examine.
• P : presentation, position, power
• S : station.
• 144. Basic rule for froceps delivery = left handed blade is applied first.
• 145. Most common Indication for forceps delivery = prolonged 2nd stage labour.
• 146. Types of cups for ventouse (vaccum) delivery = metal cup, soft cup, kiwi omni cup.
• 147. Pressure used in ventouse delivery is about 0.8kg/cm²
• 148. Most common complication of ventouse delivery = genital tract trauma in mother.
• 149. Forceps delivery can be done before 34 weeks gestation while ventouse delivery is contraindicated before 34 weeks.
• 150. Ventouse delivery is safer for mother whereas forceps delivery is safer for baby.
• 151. Most common type of breech presentation = extended breech (frank breech)
• 152. External cephalic version may be done in breech presentation when no contraindication is present 
• 153. Delivery of legs & lower body in breech presentation is done by pinard's manoeuvre, delivery of shoulder by Loveset's manoeuvre, delivery of head by using Mauriceau-Smellie-Veit manoeuvre.
• 154. Antepartum hemorrhage refers to vaginal bleeding from 24 weeks to delivery of baby.
• 155. Placental causes of APH = Placenta previa (painless vaginal bleeding, placenta in lower uterine segment), placental abruption (woody hard uterus, painful vaginal bleeding), vasa previa.
• 156. Local causes of APH = Cervicitis, cervical carcinoma & vaginal infection or trauma.
• 157. Three types of placenta previa = central (most dangerous), lateral, marginal.
• 158. C-section is the mode of delivery in placenta praevia & indicated by massive bleeding (>1500ml), mother & fetus unstable, placental edge is less than 2cm from internal os.
• 159. Placental abruption is a premature separation of normally site placenta, two types (external & internal), Cesarean section is the mode of delivery & indicated by uncontrolled bleeding or DIC, mother & fetus unstable.
• 160. Vasa praevia refers to rupture of vessels on the fetal side of placenta, bleeding aries from velamentous insertion of umbilical cord, classical triad of symptoms (rupture of membranes, painless vaginal bleeding, fetal bradycardia), managed by immediate Cesarean delivery of fetus.
• 161. Postpartum hemorrhage refers to excess blood loss after delivery.
• 162. Two types of PPH = Primary (excess blood loss more than 500ml within 24 hours of delivery) & Secondary (excess blood loss occuring between 24 hours & 6 weeks after delivery).
• 163. Most common cause of PPH = Uterine atony.
• 164. Surgical management of PPH = Temponade by intrauterine balloons, bilateral internal iliac artery ligation, hysterectomy.
• 165. Surgical management of uterine rupture = urgent lower segment Cesarean section & repair uterus.
• 166. Most common symptom of uterine inversion = hemorrhage.
• 167. Management of uterine inversion = by johnson manoeuvre, if manual reduction fails then hydrostatic repositioning (O'Sullivan's technique) may be used, if this fails too then laparotomy is needed (Haultain's procedure).
• 168. In amniotic fluid ambolism, delivery by CS within 5 minutes of cardiac arrest is recommended to facilitate CPR of mother.
• 168. Puerperium begins after the delivery of placenta & lasts until the reporductive organs have returned to their pre-pregnant state (6weeks)
• 169. After delivery, hymen converts to parous myritiformis caruncles.
• 170. Incontinence of urine after delivery should be investigated to exclude vesicovaginal fistula & urethra-vaginal fistula.
• 171. Obstetric palsy is also called traumatic neuritis in which one or both lower limbs may develop signs of a motor or sensory neuropathy after delivery, may be due to compression of lumbo-sacral trunk (herniation of lumbosacral disc usually at L4-L5).
• 172. Most common cause of puerperal pyrexia = ebdometritis
• 173. Clinical sign of puerperal sepsis = boggy, tender, large uterus, pyrexia, tachycardia, paralytic ileus, peritoneum.
• 174. Organism for puerperal sepsis = beta hemolytic streptococcus.
• 175. Treatment of endometritis = combination of clindamycin & aminoglycosides (gentamicin).
• 176. Tetracycline should be avoided in breast feeding women.
• 177. Breast extend between 2nd & 6th rib from sternum to axilla.
• 178. Montgomery's tubercles = aerola become darker & sebaceous glands become prominent during pregnancy.
• 179. Breast is comprised of 15-25 functional units, each unit is made up of a lactiferous duct, mammary gland lobule & alveoli.
• 180. Prolactin with peak levels within 45 minutes of suckling.
• 181. Colostrum is the yellowish fluid secreted by breast, expressed as early as 16th weeks of pregnancy, it has high conc. Of proteins (provide gut maturation & immunity of infant), high conc. Of secretory IgA, laxative effect on fetus & less sugar & fat than breast milk.
• 182. Major constituents of breast milk are lactose, protein, fat & water.
• 183. WHO recommends exclusive breastfeeding for 4-6 months with introduction of appropriate complementary foods after this period.
• 184. Drug of choice for Suppression of lactation = cabergoline.
• 185. Non-infective mastitis resuls from obstruction of milk drainage from one section of breast, features are swollen red painful area on breast, tachycardia, pyrexia, aching, flu like feeling.
• 186. Infective mastitis arises from nipple trauma followed by introduction of bacteria into nipple ducts. Most common cause (staph. Aureus), most common source (baby's nose), treated by flucloxacillin.
• 187. Contraception = by lactational amenorrhea for 3 months, progesterone-only pill is the hormonal method of choice in lactating women, intrauterine devices after 4 weeks postpartum, sterilization done after 6 weeks postpartum by laparoscopy, COCP should be avoided in lactating women.
• 188. Immunization after delivery = Rubella, Anti-D (500IU IM within 72 hours of delivery), hepatitis b (for high risk patients).
• 189. Postpartum pinks characterized by elevation of mood, feeling of excitement, some overactivity, difficulty sleeping occurs for first 24-48 hours following delivery.
• 190. Postpartum blues characterized by feeling of inadequacy, tearfulness, mood swings, fatigue & headache, common in 1st 2 weeks after delivery.
• 191. Puerperal psychosis presents with restless agitation, insomnia, confusion, hallucinations, delusions, failure to eat & drink, loss of insight in immediate postnatal period (usually within 3 weeks of delivery), rarely present before 3rd day (most commonly 5th day). Risk factors are history of puerperal psychosis & bipolar effective disorder, treated by electroconvulsive therapy in severe depressive psychosis.
• 192. puerperal depression usually presents later in postnatal period, most commonly around 6 weeks with gradual onset, symptoms are feeling of despair & hopelessness, tearfulness, low energy & libido, care of self & baby neglected.
• 193. Term pregnancy refers to gestational period from 37-41 weeks.
• 194. Preterm pregnancy = 24-36 weeks
• 195. Preterm labour is associated with increased vaginal discharge, mild lower abdominal pain, bulging membranes on examination.
• 196. Preterm labour diagnostic criteria = gestational age between 24-37 weeks, atleast 3 uterine contractions in 30 minutes, 2cm dilated cervix.
• 197. FFN testing offers a rapid assessment of risk of preterm birth in symptomatic women with minimal cervical dilatation (because it is not usually present in cervicovaginal secretions between 22-36 weeks, it indicates that women is likely to deliver, it predicts birth within 7 days of testing).
• 198. Tocolytic agents are used to prevent labour & delivery (magnesium sulfate, beta adrenergic agonists, calcium channel blockers, prostaglandin synthesis inhibitors).
• 199. Preterm prelabour rupture of membranes defined as leakage of amniotic fluid in the absence of uterine activity occurs between 24-36 weeks gestation, most common risk factor is ascending infection of lower genital tract, most common symptom is sudden gush of copious vaginal fluid, pool of amniotic fluid in posterior vagina on speculum examination is diagnostic.
• 200. Preterm prelabour rupture of membrane is diagnosed by speculum examination on following criteria = amniotic fluid in posterior vaginal fornix (pooling positive), fluid display ferning pattern under microscope (fern positive), fluid turns nitrazine stick black (nitrazine positive).
• 201. Chorioamnionitis is characterized by fever, abdominal pain, purulent offensive vaginal discharge, tender uterus.
• 202. According to FIGO, post term pregnancy is defined as any pregnancy that excees 42 weeks (294 days) from first day of LMP in a woman with regular 28 days cycle.
• 203. Post term pregnancy is associated with two syndormes = Macrosomia syndrome (placental function is maintained, healthy large fetus, normal amniotic fluid, shoulder dystocis is common with risk of fetal hypoxia & brachial plexus injury, risk of c-section due to prolonged or arrested labour) & Dysmaturity syndrome (placental function deteriorates, decreased amniotic fluid, oligohydramnios result in umbilical cord compression, risk of C-Section due to non-reassuring fetal heart rate pattern).
• 204. Cervical ripening is initiated with vaginal or cervial PGE2 followed by IV oxytocin.