Obstetrics and Gynecology - Dr. M Tmbool Revision Notes

Vocabulary-style flashcards covering major topics in Obstetrics and Gynecology based on the 'Qasawir' revision notes by Dr. M Tmbool.

Miscarriage

The expulsion of conception before viability, defined as occurring before $24$ weeks gestation.

Complete miscarriage

A miscarriage characterized by bleeding and pain that subsequently subsides, with the cervix found to be closed on examination.

Incomplete miscarriage

A miscarriage presenting with vaginal bleeding and pain where the cervix is open (regarded as $> 2\,cm$). USS shows a heterogeneous mass of gestational sac and fetal parts.

Threatened miscarriage

A condition with minimal vaginal bleeding and pain, a closed cervix, and USS evidence of a gestational sac, fetal pole, and fetal heart activity.

Missed miscarriage

The cessation of pregnancy symptoms without abdominal pain or bleeding; USS shows a gestational sac $> 25\,mm$ with no fetal heart activity, or fetal parts of at least $7\,mm$.

Inevitable miscarriage

A miscarriage presenting with severe pain and vaginal bleeding where the cervix is found to be open on examination.

Septic miscarriage

A severe form of miscarriage, often secondary to illegal induced abortion or septic evacuation, presenting with vaginal bleeding, abdominal pain, and systemic features of sepsis like fever and tachycardia.

Recurrent miscarriage

Defined as $\geq 3$ consecutive miscarriages from the same biological father.

Ashermann syndrome

A potential complication of Dilatation and Evacuation (D&E) involving the formation of intrauterine adhesions or uterine perforation.

Cervical weakness

The most common cause of second trimesteric miscarriage, presenting as a painless gush of liquor; managed with cervical cerclage using Mersilene tape.

McDonald’s operation

A type of cervical cerclage performed at the lower border of the cervix under local anesthesia.

Shirodkar operation

A type of cervical cerclage performed at the upper part of the cervix under general anesthesia, considered more effective but carrying more complications.

Gestational Trophoblastic Disease (GTD)

A range of diseases characterized by hyperplasia of villi and swelling of trophoblastic cells, ranging from molar pregnancy to choriocarcinoma.

Complete Molar Pregnancy

Formed by an empty ovum and one sperm with duplication of paternal sex (Diploid $46\,XX/XY$); USS shows a 'Snowstorm appearance' and absence of fetal parts.

Partial Molar Pregnancy

Formed by a normal ovum and two sperm (Triploid $69\,XXX/XXY/XYY$); fetal parts are present on USS.

Ectopic pregnancy

The implantation of a zygote outside the uterus, with the ampulla of the fallopian tube being the most common site.

Pseudo-gestational sac

A centrally-located sac within the uterine cavity seen on USS in cases of ectopic pregnancy, as opposed to the normal eccentric location.

Antepartum Haemorrhage (APH)

Vaginal bleeding occurring after $20$ weeks of gestational age.

Placenta Previa

Insertion of placental tissue in the lower segment of the uterus after $32$ weeks GA; characterized by painless, causeless bleeding.

Abruptio Placentae

Early separation of the placenta after $24$ weeks GA and before the onset of labour, presenting with severe pain and a hard, 'wood-like' tender uterus.

Couvelaire uterus

A complication of abruptio placentae where blood infiltrates the myometrium, leading to uterine atony.

Vasa Previa

A condition where fetal blood vessels cross or run near the internal opening of the uterus; characterized by a triad of fetal distress, minimum bleeding, and rupture of membranes.

Apt test (Alkali denaturation test)

A diagnostic test for vasa previa that detects fetal hemoglobin ($HbF$) in vaginal blood based on its resistance to denaturation in $1\%\,NaOH$.

PIH (Pregnancy-induced HTN)

Elevation of blood pressure $> 140/90\,mmHg$ in two readings at least $4\,hrs$ apart after $20$ weeks gestation in a previously normotensive patient, without proteinuria.

Preeclampsia

BP Elevation $> 140/90\,mmHg$ after $20$ weeks with proteinuria of $> 300\,mg/dl$ on 24-hr collection or ($1+$) on dipstick.

Eclampsia

The occurrence of generalized tonic-clonic convulsions in a patient with pre-eclampsia.

HELLP syndrome

A severe complication of pre-eclampsia characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets ($PLT < 100$).

Primary PPH

Postpartum hemorrhage occurring within the first $24\,hours$ of delivery.

Secondary PPH

Postpartum hemorrhage occurring from $24\,hours$ up to $6\,weeks$ after delivery, often due to infection or retained products.

Shoulder Dystocia

Impaction of the anterior shoulder against the maternal symphysis pubis after delivery of the head by more than $60\,seconds$.

McRoberts manoeuvre

A management technique for shoulder dystocia involving hyperflexion and hyperabduction of the maternal legs.

Zavanelli maneuver

Cephalic replacement used as a last resort in shoulder dystocia; involves tocolytics and performing a C-section.

Cord Prolapse

Prolapse of the umbilical cord below the presenting part following rupture of the membranes (ROM).

Uterine inversion

A condition where the uterus turns inside out, often due to fundal placental insertion or poor 3rd stage management, leading to neurological shock and bleeding.

Amniotic fluid embolism

Embolism of fetal tissue or amniotic fluid into maternal circulation; often diagnosed post-mortem by demonstrating fetal parts in maternal blood.

Uterine Dehiscence

Separation of the endometrium and myometrium while the serosa remains intact.

Uterine Rupture

Separation of all uterine layers from the endometrium to the serosa, often presenting with maternal shock and 'loss of station'.

Placenta Accreta

A morbidly adherent placenta that is attached to the outer part of the myometrium but not deep.

Placenta Increta

A morbidly adherent placenta that is attached deep into the uterine myometrium.

Placenta Percreta

A morbidly adherent placenta that attaches deep through the serosa and into adjacent organs like the bladder.

Thelarche

The stage of female puberty characterized by the development of breasts.

Menarche

The onset of the first menstrual cycle, typically occurring between $11-13\,years$ of age.

Primary amenorrhea

Failure to start menstruation by age $16$ with secondary sexual characteristics, or by age $14$ without them.

Secondary amenorrhea

The cessation of menses for $6\,months$ in a woman who previously had cycles.

Turner syndrome

A form of hypergonadotropic hypogonadism ($45\,XO$) featuring streak ovaries, short stature, webbed neck, and bicuspid aortic valve.

Kallmann syndrome

A form of hypogonadotropic hypogonadism characterized by failure of the hypothalamus to develop, resulting in absent olfactory bulbs and anosmia.

MRKH syndrome (Müllerian agenesis)

A congenital condition involving the complete or partial absence of the paramesonephric ducts, resulting in absence of the uterus and upper vagina.

Androgen insensitivity syndrome

A genetic male ($XY$) with a female phenotype due to gonad resistance to testosterone; features a blind-ended vagina and absence of internal female organs.

PCOS (Polycystic Ovary Syndrome)

An anovulatory disease diagnosed via the Rotterdam criteria ($2$ of $3$: Oligo/anovulation, hyperandrogenism, or polycystic ovaries on USS).

Bacterial Vaginosis

A non-inflammatory growth of Gardenella vaginalis presenting with a fishy smell (Whiff test), $pH \geq 4.5$, and 'clue cells' on microscopy.

Strawberry cervix

The clinical appearance of an inflamed, red cervix associated with Trichomonas vaginalis infection.

Fitz-Hugh-Curtis syndrome

A chronic complication of PID involving perihepatitis and the formation of adhesions around the liver.

Meigs' syndrome

A triad of an ovarian fibroma, right-sided pleural effusion, and ascites.

Spalding sign

An USS finding of overlapping fetal skull bones due to brain collapse, indicating IUFD.

Atozepam

A tocolytic agent used to manage preterm labor, described as the safest and most effective but also expensive and often unavailable.