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Obstetrics Simplified - D Obstetrics Simplified - D. El-Mowafi Obstetrics Simplified Diaa M. EI-Mowafi, MD Associate Professor, Department of Obstetrics & Gynecology, Benha Faculty of Medicine, Egypt Educator & Researcher, Wayne State University, USA Fellow, Geneva University, Switzerland Contents UNIT I : PHYSIOLOGY OF REPRODUCTION ● Physiology of reproduction ● The placenta ● The umbilical cord ● The foetal membranes and amniotic fluid ● Maternal changes due to pregnancy ● Diagnosis of pregnancy ● Antenatal care ● Minor complaints during pregnancy UNIT II : ABNORMAL PREGNANCY ● Bleeding in early pregnancy, abortion ● Ectopic pregnancy ● Hydatidiform (vesicular) mole ● Bleeding in late pregnancy, placenta praevia ● Abruptio placentae ● Marginal haemorrhage ● Hyperemesis gravidarum ● Polyhydramios and oligohydramnios ● Hypertensive disorders in pregnancy ● Heart disease in pregnancy ● Diabetes mellitus in pregnancy ● Anaemia in pregnancy ● Urinary tract infection in pregnancy ● Infectious diseases in pregnancy ● Coagulation defects in pregnancy file:///D|/Webs_On_David/gfmer/Books/El_Mowafi/Index_Obstetrics_simplified.htm (1 sur 4) [18.12.2002 16:04:13] Obstetrics Simplified - D. El-Mowafi ● Jaundice in pregnancy ● Thyrotoxicosis and epilepsy in pregnancy. Iso-immunization in pregnancy ● Abdominal pain with pregnancy ● Retroverted gravid uterus, pendulous abdomen ● Gynaecologic tumours with pregnancy ● High risk pregnancy ● Post-term pregnancy ● Preterm labour ● Premature rupture of membranes ● Tocolytic drugs UNIT III : NORMAL LABOUR ● Anatomy of the female pelvis ● Anatomy of the foetal skull ● Obstetric terms ● Normal labour ● Active management of labour UNIT IV : ABNORMAL LABOUR ● Malposition and malpresentations ● Occipito-posterior position ● Face presentation ● Brow presentation ● Compound presentation ● Breech presentation ● Shoulder presentation (transverse or oblique lie) ● Cord presentation and prolapse ● Multiple pregnancy ● Abnormal uterine action ● Prolonged labour ● Obstructed labour ● Contracted pelvis ● Dystocia due to oversized foetus ● Maternal obstetric injuries ● Complications of the third stage of labour: Postpartum haemorrhage ● Retained placenta ● Acute inversion of the uterus file:///D|/Webs_On_David/gfmer/Books/El_Mowafi/Index_Obstetrics_simplified.htm (2 sur 4) [18.12.2002 16:04:13] Obstetrics Simplified - D. El-Mowafi ● Shock in obstetrics ● Haemorrhagic shock ● Endotoxic shock ● Amniotic fluid embolism ● Cardiac arrest UNIT V : THE PUERPERIUM ● The puerperium ● Puerperal sepsis ● Breast disorders in the puerperium UNIT VI : THE FOETUS ● The foetal physiology ● Assessment of foetal maturity and wellbeing ● Intrauterine growth retardation ● Placental insufficiency ● Perinatal mortality ● Foetal asphyxia ● Congenital anomalies ● Foetal birth trauma UNIT VII : MISCELLANEOUS ● The relief of pain in labour ● Ecbolics (uterine stimulants) ● Maternal mortality ● Induction of labour ● Ultrasonography in obstetrics ● Radiology in obstetrics UNIT VIII : OBSTETRIC DIAGNOSIS ● Obstetric diagnosis UNIT IX : OPERATIVE OBSTETRICS ● Forceps delivery ● Vacuum extraction (ventouse) ● Caesarean section ● Version ● Episiotomy ● Symphysiotomy ● Destructive operations file:///D|/Webs_On_David/gfmer/Books/El_Mowafi/Index_Obstetrics_simplified.htm (3 sur 4) [18.12.2002 16:04:13] Obstetrics Simplified - D. El-Mowafi Bibliography National Library Card No. 1996/8705 I.S.B.N. 977-19-1357-3 First edition 1997 All rights are reserved to the author. No part of this book may be reproduced or transmitted in any form without prior written permission of him. Published by the author: Burg Abu-Samra ,El-Happy Land Square, El-Mansoura ,Egypt. Tel. (050)363308 Tel.(013) 223449. Fax. (050) 332771 28.11.02 Pages trouvées depuis 28.8.2001 file:///D|/Webs_On_David/gfmer/Books/El_Mowafi/Index_Obstetrics_simplified.htm (4 sur 4) [18.12.2002 16:04:13] Department of Obstetrics and Gynecology, Benha Faculty of Medicine, Zagagig University, Egypt DEPARTMENT OF OBSTETRICS AND GYNECOLOGY BENHA FACULTY OF MEDICINE ZAGAZIG UNIVERSITY, EGYPT Coordinator Diaa M. El-Mowafi, MD Associate Professor, Obstetrics and Gynecology Department Benha Faculty of Medicine Lecturer & Researcher, Wayne State University, USA Fellow, Geneva University, Switzerland 4 Ghazza Street, El-Hossania, El-Mansoura 35111, Egypt Tel. +2 050 363308 Fax +2 050 332771 Chairman : Prof. Hazim Ismail Department started in 1978. It has 48 beds. Divided into 4 units, each is supervised by a professor. The department has the following specialized units: ● Endoscopic Surgery. ● Ultrasonography. ● Colposcopy. ● Cytology. ● Fetal monitoring. file:///D|/Webs_On_David/gfmer/Books/El_Mowafi/Department.htm (1 sur 3) [18.12.2002 16:04:27] Department of Obstetrics and Gynecology, Benha Faculty of Medicine, Zagagig University, Egypt ● Assisted reproductive techniques ( in development). There are 4 operative lists every week. Emergency cases are around 15-30 cases / day. The department has its annual international congress. It organizes bi-annual training courses in: ● diagnostic and operative laparoscopy and hysterescopy, ● basic and advanced ultrasonography, ● colposcopy, ● cytology, ● fetal monitoring. The degrees that are given by the department are : ● Diploma in Obstetrics and Gynecology. ● Master degree (M.Sc.) in Obstetrics and Gynecology. ● Medical doctorate (M.D.) in Obstetrics and Gynecology. Book ● Obstetrics Simplified - D. El-Mowafi Scientific papers ● Chlamydia trachomatis in women with intermenstrual bleeding using different methods of contraception - D. El-Mowafi, U. El-Hendy ● Dilapan versus Prostaglandin E1 in Induction of Midtrimester Abortion - D. El-Mowafi, N. El-Orabi, I. El-Arousi ● Fallopian Tube - D. El-Mowafi, M.P. Diamond ● Gynecologic surgery and subsequent bowel obstruction - D. El-Mowafi, M.P. Diamond ● Laparoscopically Assisted Vaginal Hysterectomy: A Gimmick or An Advance? - D. El-Mowafi, Ch. Lall ● Maternal and Umbilical Cord Plasma Renin Activity in Pregnancy Induced Hypertension - S. Saad, M. Abd El-Hadi, D. El-Mowafi, F. El-Shenawy, A. El-Metwally ● Pelvic Adhesions - D. El-Mowafi, M.P. Diamond ● Peritoneal fluid embryotoxicity and cytokine (TNF-alpha ) level in endometriosis associated infertility - D. El-Mowafi, W. El-Mosallamy, E. Basiony, S. Ghany, R. Arafa, U. El-Hendy ● Peritoneal fluid mediated embryotoxicity in unexplained infertility - D. El-Mowafi, U. El-Hendy, R. Arafa, W. El-Mosallamy, E. Basiony, E. Ghany ● Placental Localization by Transperineal Sonography in Antepartum Hemorrhage - D. El-Mowafi, A.-F. Hegazi ● Transvaginal Sonography and Hysteroscopy Versus Histopathology in Postmenopausal file:///D|/Webs_On_David/gfmer/Books/El_Mowafi/Department.htm (2 sur 3) [18.12.2002 16:04:27] Department of Obstetrics and Gynecology, Benha Faculty of Medicine, Zagagig University, Egypt Bleeding - D. El-Mowafi, A. Farid, A. El-Badawi ● Ultrasonographic Versus Laparoscopic Control of Hysteroscopic Surgery - D. El-Mowafi ● Vaginal Dopamine Agonists: Biochemical and Clinical Responses - A New Trial - D. El-Mowafi, M. Youssef, M.A. Hassan 03.12.02 file:///D|/Webs_On_David/gfmer/Books/El_Mowafi/Department.htm (3 sur 3) [18.12.2002 16:04:27] Physiology of Reproduction - D. El-Mowafi Obstetrics Simplified Diaa M. EI-Mowafi, MD Associate Professor, Department of Obstetrics & Gynecology, Benha Faculty of Medicine, Egypt Physiology of Reproduction Pregnancy occurs when a mature liberated ovum is fertilized by a mature capacitated spermatozoon. The Sperm: ● The spermatozoa leave the testis carrying 23 chromosomes but not yet capable of fertilization. ● Their maturation is completed through their journey in the 6 meters of the epididymis and when mixed with the seminal plasma from the epididymis, seminal vesicle and prostate gland. ● After semen is ejaculated, the sperms reach the cervix by their own motility within seconds leaving behind the seminal plasma in the vagina. ● At time of ovulation, the cervical mucous is in the most favourable condition for sperm penetration and capacitation as: - It becomes more copious, less viscous and its macromolecules arrange in parallel chains providing channels for sperms passage. - Its contents from glucose and chloride are increased. ● The sperms ascent through the uterine cavity and Fallopian tubes to reach the site of fertilization in the ampulla by: 1. its own motility, 2. uterine and tubal peristalsis which is aggravated by the prostaglandins in the seminal plasma. ● The sperms reach the tube within 30-40 minutes but they are capable of fertilization after 2-6 hours. This period is needed for sperm capacitation. ● Capacitation of sperms is the process after which the sperm becomes able to penetrate the zona pellucida,that surrounding the ovum and fertilize it. The cervical and tubal secretions are mainly responsible for this capacitation. Capacitation is believed to be due to : a. increase in the DNA concentration in the nucleus, b. increase permeability of the coat of sperm head to allow more release of hyaluronidase. The ovum: file:///D|/Webs_On_David/gfmer/Books/El_Mowafi/Physiology_of_reproduction.htm (1 sur 4) [18.12.2002 16:04:28] Physiology of Reproduction - D. El-Mowafi ● The ovum leaves the the ovary after rupture of the Graafian follicle, carrying 23 chromosomes and surrounded by the zona pellucida and corona radiata. ● The ovum is picked up by the fimbriated end of the Fallopian tubes and moved towards the ampulla by the ciliary movement of the cells and rhythmic peristalsis of the tube. Fertilization: ● Millions of sperms ejaculated in
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