Embryology
Anatomy of female genital tracts
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- Urogenital sinus
- Male
- Urinary bladder
- Urethra except navicular fossa
- Prostate gland
- Prostatic utricle
- Bulbourethral glands
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- Female
- Urinary bladder, urethra
- Urethral & paraurethral glands (Skene glands)
- Vagina
- Bartholin's (greater vestibular glands)
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Skene glands:
- Homologous to prostate in males
- Largest paraurethral gland
- One pair of ducts open on either side of the external urinary meatus
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Fourchette:
- It is the area where both labia minora posteriorly meet
Bartholins gland:
- Opens between hymen & labia minora in inner aspect of labia minora (7'o clock & 5'o clock positions)
- Bartholinis cyst ? TOC: marsupialization
- Bartholen's abscess TOC: IND
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Hormonal study is taken from lateral wall of vagina
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- Vaginal defence is due to acidity of vagina is produced by estrogen. The vaginal defence is lost after 10 days of birth due to withdrawal of maternal hormone
Uterus:
- Fundus
- Body
- Internal os
- Isthmus
- Cervix
- External os
- The lining of cervix is ciliated columnar (below anatomical internal os)
- The area bounded by anatomical internal os above & histological internal os below is called the isthmus of uterus
- Corpus - cervix ratio before puberty is 1:2, at puberty is 2:1, adults - 3:1
- After menopause uterus & cervix atrophy
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Lymph node in
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Obturator lymph nodes
Fallopian tube:
- Is lined partially by ciliated & partially by non ciliated columnar epithelium
- Surrounded by peritoneum on all sides except along line of attachment of mesosalpinx
- Longest part is ampulla & is m/c site of ectopic pregnancy
- Site for tubectomy is isthmus
- Total length is 10-12 cm
- Interstitium is the narrowest part & forms anatomic sphincter whereas physiological sphincter is formed by isthmus
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Blood supply of uterus:
- Ovarian artery
- Uterine artery
- Anterior division of internal iliac arteries
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Can be ligated is uncontrollable PPH
- M/c organ & is susceptible to unintentional damage by hysterectomy is ureter
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Perineal anatomy:
- Muscles attached to perineal body are
- External anal sphincter
- Superficial transverse perinei
- Deep "
- Bulbospongiosus muscle
- Levator ani "
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- Ovary is connected to lateral pelvic wall by infundibulopelvic ligament
- Round ligament runs from fundus of uterus to labia majora
- Supports of vagina ? perineal body, pelvic diaphragm, levator ani muscle
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Vagina
- The main source of physiological secretion found in vagina is cervix
- Supplied by uterine artery
- Lined by stratified sq. epithelium
- ? posterior wall is covered by peritoneum in the form of pouch of Douglas (recto uterine pouch)
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Nabothian follicles ? d/t crown of cervix
Hematological changes in pregnancy
- Non pregnant uterus ? 70g, 15 ml, pear/ pyriform shaped
- Pregnant uterus ? 1-1.1kg, globular - spherical shaped
- Enlargement of uterus & d/t hypertrophy > hyperplasia
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Cervix
- Cervix becomes soft due to estrogen
- Eversion of cervix
- ? cervical secretion - Igs
- Corpus luteum functions maximally by 6-7 weeks of pregnancy
- pH of vagina ? 4.5 to 5.5
- During pregnancy ? 3-5 to 4.5
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Hematological changes ? begins by 6 weeks, max changes is in T2 btw 28-32 wks
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- Blood volume ?
- Plasma volume ? 40 to 50% ?
- RBC mass ? 18 - 20%?
- Hb mass ?
- Hb concentration?
- Hematocrit ?
- Viscosity ?
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Cell
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- Reticulocyte count?
- RBC count ?
- WBC count ? (upto 15,000)
- Platelet count ? (upto 1 lakh)
- Neutrophils ? (neutrophilic leukocytosis)
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Iron parameters
- Total requirement of iron during pregnancy ? 1000 mg
- In T1 ? 3-4 mg / day
- T2 & T3? 6-7 mg / day
- S. Iron & S. ferritin ? in T2
- S. transferrin?
- TIBC ?
- PSAT?
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Clotting parameters
- All clotting factors except (11 & 13) increase in pregnancy
- Masamal ? is ? factor I (Fibrinogen)
- Fibrinolytic activity is ? (d/t ?TPA & ?PAI)
- Protein c & s are ?
- Antithrombin levels are N
- BT & CT are N
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- ESR ?
- Leucocyte ALP, C3, C4, CRP, procalcitonin ? ?
- Cell mediated immunity is predominantly suppressed during pregnancy
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CVS
- HR ? by 10 bpm
- Stroke volume ?
- Cardiac output? (co)
Pospher
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- ? co starts ?ing by 5 weeks & reaches max by 32 weeks
- ? co during postpartum period > labour > pregnancy (immediate) (50%?) (40%?)
- ? co returns to prepong porelabour levels by 48 hours & prepregnant levels after peurpertum
- Both peripheral & pulmonary vascular resistance ? during pregnancy (d/t relaxin)
- ?diastolic pressure
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Pressure changes
- SBP? ?/?
- DBP? ?
- MAP? ?
- Femoral venous pressure ? (pregnancy ? 24mmHg)
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Other changes
- Apex beat moves up & out 4th Ics, lateral to mid clavicular line
- All chambers of heart ? in size & pericardial effusion+
- ? cardiac sithouette ?
- ECG? axis deviation
- S3 may be heard
- Si loud & split
- S2 no changes
- Systolic murmur (cloro grade) ? intensified during inspiration
- Diastoli ? transient soft is 20%
- Continuous murmur from breast? mammary souffle
- Uterine blood floro Tos-from 50 ml to 750 ml at term
- Retin increased
- Angiotensin?
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water retention & ? plasma volume
- Transverse diameter of chest ? by 2cm
- Circumference bem?
- Diaphragm ? move up by 4cm
- ? it obliterates RVE ERV space ?RVE ERV
- ? IRV unchanged
- ? FRC = RV+ ERV ? ?FRC
- VC (IRV+TV+ ERV) (unchanged)
- IC?
- TLC? slightly ? or N
- Respiratory rate unchanged
- Minute ventilation ? ?
- Max breathing capacity ? N
- Respiratory alkalosis ? (d/t ? min ventilation)
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Renal system
- Kidney ? by 1cm
- RPF ?
- GFR ? & tubular reabsorption ?
- Urea dearance ? serum levels
- Wicaud " creatinine.
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- All soluta ? plasma osmolality ?s
Endocrine Pituitary
- Ted GH, prolactin, ACTH, CRI, size of gland
- Jed FSH, LH
- Unchanged TSH
- Prolactin - 25 mg/ml
- Pregnancy - 150 mg/ml
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Thyroid gland
- Total T3, T4? ?
- Free T3, T4? N
- TBG - ?
- Fetal thyroid gland istarte taking sodine by 11 weath
- Fettre stants releasing thyroxine by 20 weere
- I2 req?
- Size of thyroid gland?
- TSH ? slight fall (trimester dependant)
- HCG resembles TSH, FSH, LH
- BMR ? by 25%
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Adrenal
- ODHEAS is the only adrenal hormone ted during pregnancy
- All other adrenal hormona ?
- Insulin sensitivity ? by 70% during pregnancy
- ? insulin production
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1st stage of labour;
- Begins = true labor pain & ende - full dilatation of cervix
| True labour pain | False pain |
|---|---|
| ? intensity | Irregular |
| Regular | - |
| Interval shortens | - |
| Not relieved by enema, sedation | Relieved |
| Alw Cx effacement, show & bag of membr. | Not associated |
- Full cervical dilatation ? 10 cm
- M/c presentation ? cephalex
- " attitude ? flexion
- " part ? vertex
- M/c diameter suboccipito bregmatic in Ap direction & biparietal is trane verse (both are 9.5 cm)
- ? req 10 cm dilatation
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- Full dilatation of Cx to delivery of fetus
- 3rd stage delivery of fetus to = delivery of placenta
- 4th stage ? 1hr observation after placental delivery
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1st stage of labour
- Latent ? upto 4 cm ditatation of Cx
- Active after 4 cm dilatation
- Latent phase ? 8 hrs in primi (max) & bhus iên muttigravida
- Active phase proceeds at ion thr
- ARM is done when dilatation reache 4cm
- Potal duration 12 tre un primi & 6 in meetti
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2nd stage
- 2 hrs in primi & I hon in mutti
3rd stage
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- 5 mins (due to active management)
Active phase of 1st stage
- Divided into 3 phases by Friedman's curve
- 4cm
- 10cm
- Deceleration phase
- Phase of max clope
- 3cm
- ?4cm
- Acceleration phase
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Partogram
- New partogram doant include latent phase
Components:
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- Fetal heart rate 110-160 N <100- brady >180- tachy
- Assessed every 15 min in ist stage & every 5 min in 2nd stage
- Liquor ? I- intact, C-lear, M-mecontum, B- blood ustained liquor
- Moulding indicates severity of cephalo pelvic disproportion
- 0+ ? obliteration of parietal bones, but no overriding
- 2 + ? reducible over riding
- 34 ? Breducible overriding
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- Dilatation of Cx
- ? time in X axis
- ? dilatation in Yaxis
- ? dilatation is marked by the alphabet
- Descent of head
- ? marked by '0'
- ? ascesed by crichton method (by PA)'
- ? score 5/5 to 0145
- PV is done only at where interval unless otherwise needed.
- Action lise le 4 hrs after alert deme
- Crichton scores: Y5 & 15 engaged head & 5/5 mobile bead
- Tscheal spine o station head engaged
- O station
- -2
- --
- +1
- +2
- +3
- Ischial spine
- Station of head & AFI are not present in partogram
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Contractions
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- Ideal atleast s contractione in 10 mine each for 40 seconds
- ? contraction < 20&
- ? I contraction 20-40&
- ? I contraction >40%
- ; a contractions each <20&
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- ? can be Ped upto 38 ImU/min
- Drugs administered)
- Maternal puler BP
- Temp, urine vol & urine acetone
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Abnormalities in partogram:
- Prolonged latent phase
- 1° dysfunctional labous (mk)
- ?slow progression from the very beginning
- 2° arnest of ex dilatation
- ? causes 3P
- (mk) power inadequate contraction
- Parsanger big baby
- Package
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Definite signs of separation of placenta :
- Kustner wign cord doesn't reved on pushing the uterus upward in abdomen
- Schroeder sign uterus rises in abdomen as placente pars doron into vagina (Filling of placenta in vagina)
- Gushing of blood
- Lengthening of cord
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- Uterotonic within 1 min of delivery [-m), is oxytocin 100 i.m)
- Genes controlled cord traction
- Uterine massage
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Pressure of uterine contraction
- 1st stage 50mmHg
- 2nd stage 100 mm Hg
- Non pregnant & early pregnancy ? 2 to 3 mm Hg
- Best test for adequacy of pelvis trial of labour
- Safest method for pelvimetry ? MRT
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- Overt diabetes F 2 126 mg Idl PP / RBS 2 200 mg Ide HOAIC 26.5%
Gestational DM:
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- American guidelines:
- Selective screening low risk BMI, no family past history
- 24- 28 Loke intermediate
- 2 step approach high BMI230, family bustory, part history,
- High risk BMI >30, family Ho DM, past tho DM, previous manosomic baby 74.5kg, Bad obst-history recurrent abortions, polyhydramnios (IUD
- O Sullivan test: 50g glucose ihr> <140mg/dl
- If 2140mg (dl
- 100 g GTT
- O done : 8 to 14 hore festing
- 3 day prior to teat - meab
- Unrestricted physical actinty
- 100g glucore gn & 4 samples taken
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- 1) Fasting www.FirstRanker.com Carpenter & Coust an citoria
- 1?) Ther - 180 mg Idl
- Til) a hr - 155 mg/dl
- (v) 3 hr - 140 mg Idl
- 2) WHO - no screening test, directly diagnostic test
- Afta fasting 75g glucou F - 95 mg/dl Ihr - 180 mgld! & ha - 155 t
- 3) IADPSG (unternational association of diabetes pregnancy study) no screening test -75g glucose after festing F-92 mg/dl 1 hr-180 2ha-153 LI
- 4) DIPSI (diabetea în pregnancy study group in India)
- 100% screening at booking vist
- No fasting.
- 75g of glucore & sample after 2 hours
- 4120 N 120-140 •Impaired glucose tolerana 140-200 •gestational DM >200 •overt DM
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- If glucose is bhur www.FirstRanker.com Dry do HOA,C to see if t is overt
- The complications are more en overt diabetes then GDM
- Anomaly rate in @ person 2.5%
- Anonaaly, in a perion = HbA1c 6-6.9%. ?5% 7-709% 11% 28% 15% = 10% 20%
- Human placental lactogen (HPL) all contribute to insulin resistana ? GDM
- Cortisol
- Estrogen
- Progesterone
- of HPL adi take GH ?
- Synthesed from syneyfiotrophoblast
- Lipdytic? FFA
- ? an pregnancy fasting hypoglycemia & post prandial hyperglycemia
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- 1st trimester www.FirstRanker.com www.FirstRanker.com
- Abortions - dit chromosomal abnormalities
- Hyporemeris DKA
- Cond Trimestes
- Anomalie CPD
- Macromia big placenta placenta previa
- Polyhydramnio overditension apruptio placenta malpresentation
- Cord presentation & cord prolapse
- Still birthe
- IND
- IUGR
- Preterm labour
- During labour:
- Prolonged labour
- Shoulder dystocia traumatic
- PPH < atonic
- Instrumental delivery
- LSCS
- Stel birth
- Ketoacidosis
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- Pest partum www.FirstRanker.com www.FirstRanker.com
- Subinvolution
- Infection endometritis, peurperal sepsis
- Venous thromboemboliem.
- Future DM
- Neonatal complications
- Hypoglycemia
- Hypocalcemia
- Hypokalemia
- Polycythemia hyperbilirubinemia
- ODM
- LALD I
- Cognition & memory dvorder
- Cardiomyopathy
- A macrosomia is the m/c (45%)
- Preedam pria (28%)
- ? delayed lung maturity
- Petorvon hypothesis
- Matanal ?fetal hyperglycemia hyperglycemia fetal ßpancreate celle
- Hyperplasia of Tinsutir
- Mareromia IGF
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- Firstranker's thoideabetes www.FirstRanker.com.gnancwww.FirstRanker.com
- Insulin +
- Overt DM
- Dict? 55% carb, 20% protein, 25% fat E <10%. saturated foot na
- Anomalies in ovet diabeta
- VSD, ASD, TGA, cardiomyopathy (most specific)
- ? neural tube defects
- ? renal agenesis, duplication of ureter
- ? imperforate anus, fistulas, atresias
- ? caudal regression syndrome (rare but specific)
- ? single umbilical artery
- Rx of GDM:
- Meal plan? 40% carb, 20% protein, 40% fat for 2 coks & GIT ? FL95 mg/dl Ihr 2 140 mg/dl 2hr < 120 mg/dl
- If achieved then continue med plan till end.
- If not, then etest
- Insulin regulas + intermediate 0.7-10 1kg ld in divided doses
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- If glucose ice bhur www.FirstRanker.com Dry www.FirstRanker.com ? The complications are more en overt diabetes then GDM
- Anomaly rate in @ person 2.5%
- Anonaaly, in a perion = HbA1c 6-6.9%. ?5% 7-709% 11% 28% 15% = 10% 20%
- Human placental lactogen (HPL) all contribute to insulin resistana ? GDM
- Cortisol
- Estrogen
- Progesterone
- of HPL adi take GH ?
- Synthesed from syneyfiotrophoblast
- Lipdytic? FFA
- ? an pregnancy fasting hypoglycemia & post prandial hyperglycemia
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- 1st trimester www.FirstRanker.com www.FirstRanker.com
- Abortions - dit chromosomal abnormalities
- Hyporemeris DKA
- Cond Trimestes
- Anomalie CPD
- Macromia big placenta placenta previa
- Polyhydramnio overditension apruptio placenta malpresentation
- Cord presentation & cord prolapse
- Still birthe
- IND
- IUGR
- Preterm labour
- During labour:
- Prolonged labour
- Shoulder dystocia traumatic
- PPH < atonic
- Instrumental delivery
- LSCS
- Stel birth
- Ketoacidosis
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- Pest partum www.FirstRanker.com www.FirstRanker.com
- Subinvolution
- Infection endometritis, peurperal sepsis
- Venous thromboemboliem.
- Future DM
- Neonatal complications
- Hypoglycemia
- Hypocalcemia
- Hypokalemia
- Polycythemia hyperbilirubinemia
- ODM
- LALD I
- Cognition & memory dvorder
- Cardiomyopathy
- A macrosomia is the m/c (45%)
- Preedam pria (28%)
- ? delayed lung maturity
- Petorvon hypothesis
- Matanal ?fetal hyperglycemia hyperglycemia fetal ßpancreate celle
- Hyperplasia of Tinsutir
- Mareromia IGF
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- Firstranker's thoideabetes www.FirstRanker.com www.FirstRanker.com
- Insulin +
- Overt DM
- Dict? 55% carb, 20% protein, 25% fat E <10%. saturated foot na
- Anomalies in ovet diabeta
- VSD, ASD, TGA, cardiomyopathy (most specific)
- ? neural tube defects
- ? renal agenesis, duplication of ureter
- ? imperforate anus, fistulas, atresias
- ? caudal regression syndrome (rare but specific)
- ? single umbilical artery
- Rx of GDM:
- Meal plan? 40% carb, 20% protein, 40% fat for 2 coks & GIT ? FL95 mg/dl Ihr 2 140 mg/dl 2hr < 120 mg/dl
- If achieved then continue med plan till end.
- If not, then etest
- Insulin regulas + intermediate 0.7-10 1kg ld in divided doses
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- If glucose is bhur www.FirstRanker.com Dry www.FirstRanker.com ? The complications are more en overt diabetes then GDM
- Anomaly rate in @ person 2.5%
- Anonaaly, in a perion = HbA1c 6-6.9%. ?5% 7-709% 11% 28% 15% = 10% 20%
- Human placental lactogen (HPL) all contribute to insulin resistana ? GDM
- Cortisol
- Estrogen
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This download link is referred from the post: MBBS Lecture Notes for all subjects (updated for 2021 syllabus) - All universities
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