Download MBBS Important Topics Obstetrics Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Important Topics Obstetrics Notes for MBBS 1st Year Important Topics, MBBS 2nd Year Important Topics, MBBS 3rd Year Important Topics & MBBS Final Year Important Topics.

This post was last modified on 24 July 2021

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MBBS 2021 Important Topics and Materials for 1st Year, 2nd Year, 3rd Year and Final Year

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Embryology

Anatomy of female genital tracts

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Male	Female
Urogenital sinus	Urinary bladder	Urinary bladder, urethra
	Urethra except navicular fossa	Urethral & paraurethral glands (Skene glands)
	Prostate gland	Vagina
	Prostatic utricle
	Bulbourethral glands	Bartholin's/greater vestibular gland

Skene glands:

Homologous to prostate in males
Largest paraurethral gland
One pair of ducts open on either side of the external urinary meatus

Fourchette:

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It is the area where both labia minora posteriorly meet

Bartholin's gland:

Opens between hymen & labia minora in inner aspect of labia minora (7 o'clock & 5 o'clock positions)
Bartholin's cyst TOC: marsupialization
Bartholin's abscess TOC: IND

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Hormonal study is taken from lateral wall of vagina

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 hormones

Uterus

Fundus

Body

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Internal os

Isthmus

External os

Cervix

The lining of cervix is ciliated columnar (below anatomical internal os)

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The area bounded by anatomical internal os above & histological internal or 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

m/c lymph node in

Obturator lymph nodes

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Fallopian tube:

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

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Total length is 10-12 cm
Interstitium is the narrowest part & forms anatomic sphincter whereas physiological sphincter is formed by isthmus

Blood supply of uterus:

Ovarian artery
Uterine artery can be ligated in uncontrollable PPH

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Anterior division of internal iliac arteries

m/c organ is susceptible to unintentional damage by hysterectomy is ureter

Perineal anatomy:

Muscles attached to perineal body are
- External anal sphincter
- Superficial transverse perinei
- Deep "
- Bulbospongiosus muscle
- Levator ani

Ovary is connected to lateral pelvic wall by infundibulopelvic ligament

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Round ligament runs from fundus of uterus to labia majora
Supports of vagina perineal body, pelvic diaphragm, levator ani muscle

Vagina

The main source of physiological secretion found in vagina is cervix
Supplied by uterine artery

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Lined by stratified sq. epithelium
Posterior wall is covered by peritoneum in the form of pouch of Douglas (recto uterine pouch)

Nabothian follicles due to erosion of cervix

Physiological changes in pregnancy

Non pregnant uterus → 70g, 15 ml, pear/pyriform shaped

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Pregnant uterus → 1-1.1kg, globular - spherical shaped
Enlargement of uterus is due to hypertrophy > hyperplasia

Cervix

Cervix becomes soft due to estrogen
Eversion of cervix

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↑ 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

Hematological changes

Begins by 6 weeks, more changes is in T2 between 28-32 weeks

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Blood volume → ↑
Plasma volume → 40 to 50% ↑
RBC mass → 18 - 20% ↑
Hb mass → ↑
Hb concentration → ↓

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Hematocrit ↓
Viscosity ↓
Reticulocyte count ↑
RBC count ↓
WBC count ↑ (upto 15,000)

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Platelet count ↓ (upto 1 lakh)
Neutrophils ↑ (neutrophilic leukocytosis)

Iron parameters

↑
Total requirement of iron during pregnancy → 1000 mg in T1 → 3-4 mg/day T2 & T3 → 6-7 mg/day

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S. Iron & S. ferritin ↓ in T2
S. transferrin ↑
TIBC ↑
PSAT ↓

Clotting parameters

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All clotting factors except 11 & 13 increase in pregnancy
Masamal ↑ due to factor I (Fibrinogen)
Fibrinolytic activity is ↓ (due to ↑PA & ↓TPAI)
Protan C & S are ↓
Antithrombin levels are ↓

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BT & CT are ↓

ESR ↑
Leucocyte ALP, C3, C4, CRP, procalcitonin ↑
Cell mediated immunity is predominantly suppressed during pregnancy

CVS

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HR ↑ by 10 bpm
Stroke volume ↑
Cardiac output → ↑↑
Peripheral output → CO starts rising by 5 weeks & reaches max by 32 weeks → CO during postpartum period > labour > pregnancy (immediate) (50%↑) (40%↑) → CO returns to prepog prelabour levels by 48 hours & prepregnant levels after peurpertum
Both peripheral & pulmonary vascular resistance ↓↓ during pregnancy (due to relaxin) ↓ diastolic pressure

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SBP → ↓
DBP → ↓↓
MAP ↓
Femoral venous pressure →↑↑ (8mm Hg pregnancy → 24mm Hg)

Other changes

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Apex beat moves up & out → 4th ICS, lateral to mid clavicular line
All chambers of heart ↑ in size & pericardial effusion ↑ :. cardiac silhouette ↑
ECG axis deviation
S3 may be heard
S1- loud & split

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S2 - no changes
Systolic murmur (cloro grade) → untencified during inspiration
diastolic → transient soft is 20%
Continuous murmur from breast → mammary souffle
Uterine blood flow ↑↑ as- from 50 ml to 750 ml at term

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Renin increased water retention & ↑ plasma volume
Angiotensin→↑↑

Transverse diameter of chest ↑ by 2cm ↑TV (tidal volume)
Circumference → 6cm↑
Diaphragm → moves up by 4cm

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It obliterates RV & ERV space → ↓RV & ERV
IRV unchanged
FRC = RV+ ERV →↓ FRC
VC (IRV + TV + ERV)→↓ (unchanged)
IC→↑

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TLC→ slightly ↑ or ↓
Respiratory rate unchanged
Minute ventilation → ↑
Max breathing capacity → ↓
Respiratory alkalosis ↑ (due to ↑ min ventilation)

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Renal system

Kidney ↑ by 1 cm
RPF ↑
GFR ↑ tubular reabsorption ↑
Urea clearance ↑↑ serum levels

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Uric acid ↓
Creatinine ↓

All solutes ↓ plasma osmolality ↓

Endocrine - Pituitary

↑ed GH, prolactin, ACTH, CRH, size of gland

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↓ed FSH, LH
Unchanged TSH
Prolactin ↓ - 25 mg/ml pregnancy - 150 mg/ml

Thyroid gland

Total T3, T4→ ↑

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Free T3, T4→ ↓
TBG - ↑
Fetal thyroid gland starts taking iodine by 11 weeks
Fetus starts releasing thyroxine by 20 weeks
I2 req→ ↑

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Size of thyroid gland→↑
TSH slight fall (trimester dependant)
HCG resembles TSH, FSH, LH
BMR ↑ by 25%

Adrenal

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DHEAS is the only adrenal hormone ↓ed during pregnancy
All other adrenal hormone ↑
Insulin sensitivity ↓ by 70% during pregnancy →↑ insulin production

1st stage of labour:

Begins = true labor pain & ends = full dilatation of cervix

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True labour pain	False pain
↑ intensity	-
Regular	Irregular
Interval shortens	-
Not relieved by enema, sedation	Relieved
Also Cx effacement, show & bag of membr.	Not associated

Full cervical dilatation → 10 cm
m/c presentation → cephalic
attitude → flexion
part → vertex
m/c diameter → suboccipito bregmatic in AP direction & biparietal is transverse (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 → 1 hr observation after placental delivery

1st stage of labour

Latent → upto 4 cm dilatation of Cx

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Active → after 4 cm dilatation
Latent phase → 8 hrs in primi (max) & 6hrs in multigravida
Active phase → proceeds at 1 cm/hr
ARM is done when dilatation reaches 4 cm
Total duration → 12 hrs in primi & 6 hrs in multi

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2nd stage

- 2 hrs in primi & 1 hr in multi

3rd stage

5 mins (due to active management)

Active phase of 1st stage

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Divided into 3 phases by Friedman's curve

10cm

9cm

Deceleration phase

Phase of max slope

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3cm

4cm

Acceleration phase

Partogram

New partogram doesn't include latent phase

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Components:
- Fetal heart rate (N→ 110-160 ↓ <100 → brady assessed every 15 min >180→ tachy in 1st stage & every 5 min in 2nd stage
- Liquor → I- intact C-clear M-meconium B- blood stained liquor
- Moulding indicates severity of cephalo pelvic disproportion 0+ → obliteration of parietal bones, but no overriding 2 + → reducible over riding 3+ → Irreducible overriding

Dilatation of Cx

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→time in X axis
→dilatation in Y axis
→ dilatation is marked by the alphabet (X)
Descent of head is marked by 'O' →ausesed by crichton method (by PA) → scores 5/5 to 0/15
PV is done only at 4hrs interval unless otherwise needed.

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action line is 4 hrs after alert line
Crichton scores: 1/5 - 4/5 & 0/5 engaged head & 5/5 mobile head
Ischeal spine → 0 station → head engaged

O station

-2

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-1

Ischial spine

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Station of head & AFI are not present in partogram

Contractions

Ideal atleast 5 contractions in 10 mins each for 40 seconds
→ 1 contraction < 20s ; → 2 contractions each < 20s
→ 1 contraction > 40s

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→ can be Fed upto 32 ImU/min
Drugs administered
Maternal pulse BP
Temp, urine vol & urine acetone

Abnormalities in partogram:

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Prolonged latent phase
1º dysfunctional labour (m/c) → slow progression from the very beginning
2° arrest of ex dilatation → causes 3P's (m/c)→ power → inadequate contraction • parsanger → big baby • passage

Definite signs of separation of placenta:

Kustner sign→ cord doesn't reved on pushing the uterus upward in abdomen

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Schroeder sign→ uterus rises in abdomen as placenta pars down into vagina (Filling of placenta in vagina)
Gushing of blood
Lengthening of cord

Uterotonic within 1 min of delivery [-m/c is oxytocin 10 v.i.m)
Geners controlled cord traction

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Uterine massage

Pressure of uterine contraction

1st stage → 50 mmHg
2nd stage → 100 mm Hg
Non pregnant & early pregnancy → 2 to 3 mm Hg

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Best test for adequacy of pelvis trial of labour
Safest method for pelvimetry → MRI

Overt diabetes:

F ≥ 126 mg Idl
PP / RBS ≥ 200 mg Idl

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HOA1C ≥ 6.5 %

Gestational DM:

American guidelines :
- Selective screening
- 24-28 wks
- 2 step approach
- High risk → low risk BMI, no family past history intermediate high BMI≥30, family history, part history,
- BMI >30, family H/o DM, past H/o DM, previous manosomic baby >4.5 kg, Bad obst history recurrent abortions, polyhydramnios (IUD
O Sullivan test: 50g glucose 1hr <140mg/dl If ≥140mg Idl ↓ 100 g GTT
- Done - 8 to te hore festing
- 3 day prior to teat - N meas
- Unrestricted physical actinty
- 100g glucose gn & 4 samples taken

1) Feeting - i) fasting - www.FitstRanker.com ii) 1hr - 180 mg Idl Carpenter & Coustan criteria iii) 2 hr - 155 mg/dl iv) 3 hr - 140 mg Idl
2) WHO - no screening test, directly diagnostic test
- afta fasting → 75g glucou F - 95 mg/dl 1hr-180 mgld! 2 ha - 155 "
3) IAD PSG (international association of diabetes pregnancy study) → no screening test
- -75g glucose after fasting F-92 mg/dl 1 hr-180 " 2h-153 "
4) DIPSI (diabetea în pregnancy study group in India)
- 100% screening at booking viết
- no fasting.
- 75g of glucose & sample after 2 hours

<120 120-140 140-200 >200

•Impaired glucose gestational •overt DM

tolerana DM

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If glucose is the www.FirstRanker.com do HbAic to see if it is overt
The complications are more en overt diabetes than GDM
Anomaly rate in (N) person 2.5%
anonaaly, in a person HOAIC 6-6.9%. → 5% 7-70910→ 11% ≥8% 15% ≥ 10% 20%
Human placental lactogen all continbutes to ↑ (HPL) insulin resistana cortisol ↓ estrogen GDM progesterone

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HPL ads like GH ↓ synthesused from syncytiotrophoblast
lipdytic→↑ FFA
:. an pregnancy → fasting hypoglycemia & post prandial hyperglycemia

1st trimester abortions - alt chromosomal abnormalities
hyperemeris DKA

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ond Trimester
- anomalia CPD
- macromia big placenta placenta previa
- polyhydramne overdetension aperuptio placenta malpresentation
- cord presentation & cord prolapse
- still birthe
- IUD
- IUGR
- preterm labour
During labour
- prolonged labour
- shoulder dystocia
- traumatic PPH< atonic
- instrumental delivery
- LSCS
- stiu birth
- Ketoacidosis

Postpartum
- subtinvolution
- infection endometritis, peurperal sepsis
- venous thromboemboliem
- future DM
Neonatal complications
- hypoglycemia
- hypocalcemia
- hypokalemia
- polycythemia hyperbilirubinemia
- DM
- Low IQ
- cognition & memory disorder
- cardiomyopathy
macrosomia is the m/c (45%)
pre edam pria (28%)
delayed lung maturity

Peterson hypothesis

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matanal → fetal hyperglycemia hyperglycemia
hyperplasia of ↑ insulin fetal & pancreatic celle
mareromia IGF

Treat attenther' sothoidiabetes in pregnancy:
Overt DM → • insulin + • Diet → 55% carb, 20% protein, 25% fat E <10%. saturated fat ne

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anomalies is overt diabetes
- VSD, ASD, TGA, cardiomyopathy (most specific)
- → neural tube defecto
- → renal agenesis, duplication of ureter
- → em perforate anus, fistulas, atresias
- → caudal regression syndrome (rare but specific)
- → single umbilical astory.
Rx of GDM :
- meal plan 40% carb, 20% protein, 40% fat for 2 coke & GTT ↓ F<95 mg/dl 1hr < 140 mg/dl if achieved then 2hr < 120 mg/dl continue med plan till end.
- If not, then start insulin regulas + intermediate 0.7-10 1kg ld in divided doses

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If glucose is the www.FirstRanker.com Dy do HbAic to see if it is overt
The complications are more en overt diabetes than GDM
Anomaly rate in (N) person 2.5%
anonaaly, in a person HOAIC 6-6.9%. → 5% 7-70910→ 11% ≥8% 15% ≥ 10% 20%
Human placental lactogen all continbutes to ↑ (HPL) insulin resistana cortisol ↓ estrogen GDM progesterone

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HPL ads like GH ↓ synthesused from syncytiotrophoblast
lipdytic→↑ FFA
:. an pregnancy → fasting hypoglycemia & post prandial hyperglycemia

1st trimester abortions - alt chromosomal abnormalities
hyperemeris DKA

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ond Trimester
- anomalia CPD
- macromia big placenta placenta previa
- polyhydramne overdetension aperuptio placenta malpresentation
- cord presentation & cord prolapse
- still birthe
- IUD
- IUGR
- preterm labour
During labour
- prolonged labour
- shoulder dystocia
- traumatic PPH< atonic
- instrumental delivery
- LSCS
- stiu birth
- Ketoacidosis
Postpartum
- subtinvolution
- infection endometritis, peurperal sepsis
- venous thromboemboliem
- future DM
Neonatal complications
- hypoglycemia
- hypocalcemia
- hypokalemia
- polycythemia hyperbilirubinemia
- DM
- Low IQ
- cognition & memory disorder
- cardiomyopathy
macrosomia is the m/c (45%)
pre edam pria (28%)
delayed lung maturity

Peterson hypothesis

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matanal → fetal hyperglycemia hyperglycemia
hyperplasia of ↑ insulin fetal & pancreatic celle
mareromia IGF

Treat attenther' sothoidiabetes in pregnancy:
Overt DM → • insulin + • Diet → 55% carb, 20% protein, 25% fat E <10%. saturated fat ne

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anomalies is overt diabetes
- VSD, ASD, TGA, cardiomyopathy (most specific)
- → neural tube defecto
- → renal agenesis, duplication of ureter
- → em perforate anus, fistulas, atresias
- → caudal regression syndrome (rare but specific)
- → single umbilical astory.
Rx of GDM :
- meal plan 40% carb, 20% protein, 40% fat for 2 coke & GTT ↓ F<95 mg/dl 1hr < 140 mg/dl if achieved then 2hr < 120 mg/dl continue med plan till end.
- If not, then start insulin regulas + intermediate 0.7-10 1kg ld in divided doses

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If glucose is the www.FirstRanker.com Dy do HbAic to see if it is overt
The complications are more en overt diabetes than GDM
Anomaly rate in (N) person 2.5%
anonaaly, in a person HOAIC 6-6.9%. → 5% 7-70910→ 11% ≥8% 15% ≥ 10% 20%
Human placental lactogen all continbutes to ↑ (HPL) insulin resistana cortisol ↓ estrogen GDM progesterone

--- Content provided by‍ FirstRanker.com ---

HPL ads like GH ↓ synthesused from syncytiotrophoblast
lipdytic→↑ FFA
:. an pregnancy → fasting hypoglycemia & post prandial hyperglycemia

1st trimester abortions - alt chromosomal abnormalities
hyperemeris DKA

--- Content provided by‍ FirstRanker.com ---

ond Trimester
- anomalia CPD
- macromia big placenta placenta previa
- polyhydramne overdetension aperuptio placenta malpresentation
- cord presentation & cord prolapse
- still birthe
- IUD
- IUGR
- preterm labour
During labour
- prolonged labour
- shoulder dystocia
- traumatic PPH< atonic
- instrumental delivery
- LSCS
- stiu birth
- Ketoacidosis
Postpartum
- subtinvolution
- infection endometritis, peurperal sepsis
- venous thromboemboliem
- future DM
Neonatal complications
- hypoglycemia
- hypocalcemia
- hypokalemia
- polycythemia hyperbilirubinemia
- DM
- Low IQ
- cognition & memory disorder
- cardiomyopathy
macrosomia is the m/c (45%)
pre edam pria (28%)
delayed lung maturity

Peterson hypothesis

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matanal → fetal hyperglycemia hyperglycemia
hyperplasia of ↑ insulin fetal & pancreatic celle
mareromia IGF

Treat attenther' sothoidiabetes in pregnancy:
Overt DM → • insulin + • Diet → 55% carb, 20% protein, 25% fat E <10%. saturated fat ne

--- Content provided by‍ FirstRanker.com ---

anomalies is overt diabetes
- VSD, ASD, TGA, cardiomyopathy (most specific)
- → neural tube defecto
- → renal agenesis, duplication of ureter
- → em perforate anus, fistulas, atresias
- → caudal regression syndrome (rare but specific)
- → single umbilical astory.
Rx of GDM :
- meal plan 40% carb, 20% protein, 40% fat for 2 coke & GTT ↓ F<95 mg/dl 1hr < 140 mg/dl if achieved then 2hr < 120 mg/dl continue med plan till end.
- If not, then start insulin regulas + intermediate 0.7-10 1kg ld in divided doses

--- Content provided by‍ FirstRanker.com ---

If glucose is the www.FirstRanker.com Dy do HbAic to see if it is overt
The complications are more en overt diabetes than GDM
Anomaly rate in (N) person 2.5%
anonaaly, in a person HOAIC 6-6.9%. → 5% 7-70910→ 11% ≥8% 15% ≥ 10% 20%
Human placental lactogen all continbutes to ↑ (HPL) insulin resistana cortisol ↓ estrogen GDM progesterone

--- Content provided by‍ FirstRanker.com ---

HPL ads like GH ↓ synthesused from syncytiotrophoblast
lipdytic→↑ FFA
:. an pregnancy → fasting hypoglycemia & post prandial hyperglycemia

Ectopic pregnancy
m/c location → ampulla of FT (70%)

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Risk factors
- abnormal fallopian tube
- Tubectomy
- prior ectopic pregnancy
- salpingitis & other infection (PID) N.gonorrhoeae chlamydia (m/c)
- salpingitis isthmica nodosa
- ART (artificial reproductive technique)
- smoking
- Copper & progestin releasing IUDs
- progestin only contraceptives (Pop on minipille)

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No wut in combined ocpe
CF:
- pain abdomen (acute)
- amenorrhoea
- vaginal bleeding
- tenderness on PA ex.

Outcomes in ectopic pregnancy
- Tubal nupture
- abortion
- pregnancy failure & resolution

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→ Rupture in 1st few weeks isthmic portion
→ ampulla is more distensible
→ nupture occurs later in interstitium
→ pregnancy survives longer in ampulla
→ Tubal abortion fimbrial & ampullary pregnancies

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Diagnosi
- Qualitative (urine UPT)
- Quantitative
- Transvaginal USG (TV USG)
- laparoscopy
- laparotomy

+ UPT & abd pain/ vaginal bleeding

Stable pt Unstable pt

↓ ↓

TV-USG non diagnostic serum surgical &

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↓ BhCG

to accordingly

In pregnancies, doubting of BhCG occurs in 48 hours
dent discriminatory one is the level of BhCG above s Failure to visualise an intrauterine pregnanay indicates that either pregnancy is not alive or is an ectopic pregnancy.
usually around 1500mlU/ml

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serial follow up E TVS & BhCG te necessary
Sermon porogesterone levels
- N pregnancy 225 ng / ml
- values <5 ng/ml nonliving uterine / ectopic pregnancy
TVS
- Endometrial findings pseudogestational sac
- anechope flued collection within endometrial cavity.
- centrally located within the uterus
- Irregular in outline
- double ring sign due to chorion is absent
  This download link is referred from the post: MBBS 2021 Important Topics and Materials for 1st Year, 2nd Year, 3rd Year and Final Year
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This post was last modified on 24 July 2021

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