Management of conjoined twin :
اذا ماكو فرصة الهم يعيشون ف vaginal delivery
اذا اكو الهم امل انو نفصلهم ويعيشون فنجيبهم بال C.S ورا destructive operation
محاضرة د سمية الأولى الاوقات
7 h....... capacitation.... في uterine tube
30 h........ Blastomeres تتكون في uterine tube
3 day.......... Morula
عددهن 16_32 Blastomeres
4 day........ Morula reach the uterine cavity
يعني توصل لرحم
خلال هذه المرحلة يتغير اسم morula الى blastocyst
ال Blastocyst تنقسم إلى
Trophoblast
Embryoblast
5 day........zona pellucida degeneration
يعني تتدمر zona pellucida
6 day........ Blastocyst begins implantation
تبدي تخترق جدار الرحم
7 day........ Trophoblast differentiated into
تنقسم إلى
Cytotrophblast
Synctotrophoblast
8 day...... Blastocyst embedded in endometrium
باليوم الثامن تلتصق فقط
End 1 week........ Blastocyst implanted in endometrium
تبدي تنزرع او تتحد مع طبقه الرحم
11_12 day....... Blood filled lacunae in Synctotrophoblast
13 day....... Primary choronic villi تتكون
من المسؤول عن تكوين HCG؟.
قلب
5 w.... Cardiac output increase
First 2 day..... يكون C. O+heart rate
عالي بعد الولاده
First 2w.......... C.o falls rapidly
6w....... بعد الولاده قارن C.o
الحامل مع غير الحامل
24 w....... يقل نسبه C.o اقل من 5 L/min
...........................................
النسب
5_7 L/min......... C. O
اكثر من 7ml/min يكون نسبه C. O في بدايه labor
Sepsis
اهم سبب لموت الامهات قبل سنه 1937 لان قبل ما كو antibiotics
* antepartum
اهم اسباب bleeding هن
1. Placenta previa
2 placenta abruption
* postpartum
اهم سبب هو placenta percreta
* اهم اسباب indirect هي امراض القلب الي هو rheumatic heart disease
*fetal hypoxia may be lead to brain damage (t)
*Hypotension and hypertension will be consider as Maternal causes for fetal distress during labour(t)
*congenital abnormality of umbilical cord like Single umbilical artery and Short-cord are affect on fetal during labour (t)
*Fetal assessment in labour there are 4 or 5 options , one of them is assessment amniotic fluid (t)
*fetal monitoring at labour must be assessment in all labour whither Low risk labour or High risk labour (t)
*Intrauterine growth restriction and Multiple pregnancy consider as fetal problem which need Fetal assessment in labour (t)
*Pinard stethoscope is device used for Continuous FHR monitoring at labour (f)
*Intermittent auscultation of FHR will be done every 15 minutes in second stage of labour. (f)
*initial assessment for fetal by Intermittent auscultation may be shift to CTG if abnormal FHR ( t)
*Cardiotocography will be assess the fetal heart rate only (f)
*output from the CTG machine producing two ‘lines’, one a tracing of fetal heart rate and a second a tracing of uterine activity. (t)
*Fetal tachycardias ; can be associated with maternal or fetal infection (t)
*Fetal bradycardia; can be associated with fetal hypoxia (as a late sign) (t)
*accelerations will be increase in heart rate more than 15 bpm ,lasting 1 minute (f)
*decelerations increases in the baseline fetal heart rate of at least 15 bpm, lasting for at least 15 seconds.(f)
*Early deceleration is physiological condition due to vagal nerve stimulation . (t)
*Late decelerations is physiological condition due to vagal nerve stimulation . (f)
أسئلة #د_أزدهار للمحاضرة الخامسة و الاخيرة
#gynecology
the thrombin is factor VII a will be convert fibrinogen to fibrin (f)
the tissue factor and binding factor VII a are inhibiting plasminogen converting plasmin in helping of cytokines lead to to thrombosis large vessels (f)
DIC is systemic activation of the coagulation, Furthermore patient exhibit a tendency for sever bleeding (t)
Non obstetrical causes for DIC is Trauma and sepsis, Obstetrical causes
Placental abruption and
Postpartum bleeding (t)
the most common clinical feature ofor DIC is Hypovolemic shock (f)
there is single laboratory test to diagnose DIC because it is secondary phenomena (f)
The diagnosis is based on clinical suspicion and supportive laboratory tests (t)
The international society of Thrombosis Hemostasis (ISTH) develop a scoring system for the diagnosis of placental abruption (f)
scoring system ISTH is done based on Thrombocyte count and Fibrin split products or D-Dimer only (f)
When the scores are equal to 4, you must retake the test in order to diagnose the DIC (t)
It is a part of treatment DIC , Whole blood willbe Contain 500 ml lead to Increase serum fibrinogen and platelets (t)
patients without bleeding and platelet count less than 30 , you must give Platelet suspensions (t)
4 Pints of Fresh frozen plasma increase serum fibrinogen by 5-10 mg/dl . (t)
the patient have congenital isolated fibrinogen deficiencies , cryoprecipitate shuuld be used. (t)
Cryoprecipitate (1 pint) contain 40 ml and for (2 pints) increase serum fibrinogen by 10 g . ( f)
treatment of DIC involve:
1, obstetrician, physician, hematologist and anesthetist.
2, need correct the underlying obstetrical cause
3, correct the coagulation disorders.
4, all of above
الجواب نقطة 4
أسئلة #د_أزدهار للمحاضرة الثالثة
#gynecology
Maternal blood volume expands during pregnancy; begins at 10 weeks (f)
blood volume expands during pregnancy it’s normal physiology (T)
total body water increases from 6.5 to 8.5 L by the early of pregnancy . (f)
Maternal blood volume expand and fluid retention and changes in blood volume are unclear. (t)
decrease in haemoglobin concentration and Haematocrit it’s physiologic anaemia. (t)
iron stores well be depletion at six months after delivery and hypercoagulable state, which returns to normal around 4 weeks after delivery. (t)
ECG changes at during pregence include right axis deviation (f)
In normal pregnancy, cardiac output increases (30-50 % ). (t)
In normal pregnancy, cardiac output increases as early as 5 months gestation . (f)
cardiac output returns normal at 24 weeks after delivery .(t);
Regarding for Respiratory Tract they are all correct except ;
1 .increases in pulmonary blood flow in pregnancy
2. lung volumes change slightly
3. diaphragm is elevated 4 cm by the enlarging uterus,
4 .Ventilation begins to increase significantly at around 18 weeks of gestation.
5. congestion and rhinitis
الجواب نقطة 4
اسئلة #د_أزدهار للمحاضرة الاولى
#gynecology
Obstetric palsy
الاعراض
Parasthesia
hypoasthesia
footdrop
sciatic pain
musclewasting
السبب بالسابق كان
Compression or stretching of lumbosacral trunk
اما الان ف يعتقدون السبب
Herniation of lumbosacral disce
الي يحدث ب
Instrumental delivery
lithotomy
مهم ركزت عليهه الدكتورة
اسباب ال secondary postpartum hemorrhage :
1..most common cause retained piece of placenta
2..other cause like
Endometritis
Hormonal contraception
Bleeding disorder ( von willebrands disease )
Choriocarcinoma
اهم complication تواجة النساء بفترة النفاس هي perineal discomfort
80 بالمية من النساء راح يعانن من ألم بأول 3 ايام من فترة النفاس
وربعهن راح يستمر عدهن الالم ليوم 10 بفترة النفاس
هاي المشكلة اكثر شيء تصير عند النساء الي ولدن
Instromental delivary
علمود نخفف هذا الالم
مرات راح نستخدم تبريد موضعي الي هو
Crush ice, witch hazel or tap water
وكذلك نستخدم
Topical anesthesia (5 percent lignocain gel)
هذا راح يخفف الالم لفترة قصيرة فقط.
افضل مخفف الم استخدمة اذا صار عدنا perineal truma هو ال paracetamol
واذا اضطرينة ف ممكن ننطيها diclofenace ايضا ويكون orally or rectally
ال codeine derivatives نتجنبة لان يسوي constipation
Spontenous opening of repaired perineal tears and episiotomies is usually the result of secondary infection
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اذا اجتي اعراض
Offensive lochia
Tender uterus
Pyrexia
فالاغلب اكو infection
ونعالجة ب broad spectrum antibiotic
Management
نحاول باابداية نثبط هالشغلة من خلال ننطي anesthesia
اذا فشلت
فنلجأ لشيء اسنة decapitation نضحي بالطفل الاول ( وهو غالبا ميت ) نكص ركبتة حتى نجيب الطفل الثاني
التنفس
8w.......ventilation begins increase
.......................
4cm......... ارتفاع diaphragm muscle
5cm...... Lower ribcage circumference expands
الدم
6_8 w.... Expansion of blood volume
بدايه زياده الدم
32_34 w...... Plateaus
لهذا الوقت تتوقف الزياده ويستقر عند نسبه معينه
36 w.... Hemoglobin falls
يقل نسبه HB
6 m ..... يستمر نقص بعد الولاده ferritin
4w.......hypercoagulable returns after delivery
بعد 4 اسابيع يلا تبدي عوامل التخثر ترجع لنسبه الطبيعية
................................................
النسب الدم
8_10 بوحده kg...... يمثل وزن الاكتسبته الام
6,5_8,5 بوحده L...... كميه الكلية لزيادة water
280 بوحده ml تمثل نسبه زياده اليلازما
13,3 بوحده g/dl.......... كميه HB اذا non pregnancy
10,9 بوحده g/dl..... كميه HB في pregnancy
300 بوحده mg/dl نسبه Fibrinogen في non pregnancy
450 بوحده mg/dl نسبه Fibrinogen في pregnancy
*Hyperemesis gravidarum and HELLP syndrome are diseases caused jaundice in pregnancy and these are related to pregnancy not coincident (t)
*Normal physiological changes decrease leaves of Alpha fetoprotein and Alkaline phosphatase (f)
*Hyperemesis gravidarum will be happen in the first trimester and typically resolves by 25 weeks gestation (f)
*Liver test abnormalities are common and Jaundice are uncommon in Hyperemesis gravidarum (t)
*persistent vomiting is clinical feature for Hyperemesis gravidarum and persistent pruritus for Intrahepatic cholestasis of pregnancy (t)
*Intrahepatic cholestasis of pregnancy
Occurs in incidence about 0.3-5.6% and it is the most rare liver disease in Pregnancy.(f)
*Advanced maternal age and patients with hepatitis C these are considered risk factors for increase chances Intrahepatic cholestasis of pregnancy (t)
*there is a risk of preterm labor due to Hyperemesis gravidarum and Intrahepatic cholestasis in pregnancy (t)
*Intrahepatic cholestasis of pregnancy there is decrease bile salts and increased bilirubin level (f)
*Treatment of Intrahepatic cholestasis of pregnancy is Delivery at 37 weeks of gestational age.(t)
*vitamin k supplementation to woman and to the neonate in case Hyperemesis gravidarum (f)
*Preeclampsia is characterized by new onset hypertension and proteinuria after 30 weeks of gestation.(f)
*HELLP syndrome is characterized by hemolytic anemia, increased liver enzymes, and increase platelets.(f)
*Risk factors for HELLP syndrome are advanced maternal age and multiparous (f)
*Hypertension and proteinuria should be expected in case HELLP syndrome (t)
*pregnant women with right upper quadrant pain with fever, whereas abdominal swelling or shock presentation can occur with hepatic rupture. (t)
*Blood pressure control is important point in case HELLP SYNDROMES (t)
*Termination of pregnancy is not indicator with HELLP SYNDROME (f)
*Surgery indicated only in unstable patient with hepatic hematoma in HELLP syndrome (t)
*twin pregnancies are risk factors for Hyperemesis gravidarum and Acute fatty liver disease of pregnancy (t)
*Clinical features of viral hepatitis in pregnancy are Hepatitis A ; Abrupt onset and B; prolonged onset . (t)
*Trans placental , breast feeding and Salivary contamination are Routes of transmission for Hepatitis A (f)
*Serological screening for all pregnancy ( routinely ) for Hepatitis C and not routinely Hepatitis B (f)
*increased progesterone levels, during pregnancy will be increase chance gall stone formation (f)
أسئلة #د_أزدهار للمحاضرة الرابعة
#gynecology
dental caries is commen in phylogecal changes durning pregnancy (t)
Pregnancy gingivitis is the term used for inflammation and hyperplasia of the
gingival mucosa occurring during puerperium (f)
tooth mobility will be decreased and teeth usually retain their structure (f)
Gastric motility decreases and increased stomach volume will be lead increased risk of aspiration of gastric contents when sedated after 10 weeks gestation (f)
Nausea and vomiting will be happen due to oestrogen and progesterone hormones (f)
palpation of liver during pregnancy is difficult due to expanding uterus (t)
palmar erythema is pathological chenges during pregnancy (f)
the cause of palmar erythema is increasing progesterone hormones (f)
pregnant women more liable for Biliary stasis (t)
Dilatation of ureters and renal pelvis consider normal changes (t)
decrease creatinine , urea and presence glycosuria is normal changes (t)
Hyperpigmentation; can be localized or generalized and affects almost 100 % of pregnant
women (f)
linea nigra is a white line along the midline of the abdomen (f)
increase in the number of naevi will be regress after delivery,but may recur in subsequent pregnancies.(t)
increase in the number of naevi may be change to malignant (f)
chloasma , is an acquired hypermelanosis will be regresses after delivery but may persist in less than 10 %of those affected. (t)
greasy skin especially on the face. will be increased during the first half of pregnancy (f)
Montgomery tubercles are small sebaceous glands on axilla (f)
Acne may also commence during pregnancy (t)
weight gain vary across of all trimesters of pregnancy (t)
Weight gain during pregnancy at first trimester abute 3kg ( f)
fasting plasma glucose concentrations are reduced during the second half of pregnancy (f)
woman with gestational diabetic will be enhanced for breast lactation (t)
During lactation, glucose levels will be increased and relative insulin resistance.( f)
Around 40 per cent of circulating calcium is bound to albumin (t)
hypertriglyceridemia is considered as a changes during pregnancy due to affect Human chorionic gonadotrophin (f)
In late pregnancy, fat mobilization is enhanced to preserving preserving glucose and amino acids for the fetus.(t)
Immune response altered, but not deficient (t)
Decrease in symptoms of some autoimmune disorders(t)
adaptive changes of maternal adaptation for Calcium metabolism is includes
1,Increasing gut absorption
2,Mobilizing skeletal calcium reserves 3,Restricting renal losses.
(t)
Hormones produced within the pregnant uterus
1, pregnancy spesific hormone like human placental lactogen
2, hypothalamus like prolactin
3. pregnancy specific like Gonadotrophin-releasing hormone
(t,f,f)
choose most appropriate answers in endocrine changes
1. decrease level prolactin
2. decrease level human growth hormone
3.decrease level corticosteroid hormone
4. none all above
الجواب نقطة 2
اسئلة #د_أزدهار للمحاضرة الثانية
#gynecology
ال infection of perineum تكون uncommon
اعراض ال infection
redness, heat, swelling, pain
العرض الاكثر خطورة هو ارتفاع درجة الحرارة ولازم ننتبة الة
ف لازم ناخذ swab ونروح نزرعها ونشوف النتيجة
ننطي antibiotic يكون broad spectrum
اذا عدنا pus نسويلة drainage
ممكن يجيني ك pyrexia
وعلامات الالتهاب بال perineum
وممكن بمكان ال suture الكة تجمع pus
انطي broad specturum antibiotic
لازم نجيك اال pulse , T , ال urinary وال bowel function وال breast exam وال lochia وال uterine involution وال perineal inspection
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ال internal os تنغلق كليا بنهاية الاسبوع الثاني
ال external os تبقى مفتوحة وتدل انو المرية جايبة قبل
