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Page Special Thanks to Abrar Allafi for Her Amazing Help In Special thanks to Abrar Allafi for her amazing help in summarizing lectures. 1 | P a g e Special tanks to Abrar Allafi for her major contribution in summarizing some lectures. Team members : ( A → Z ) 1. Abrar Allafi 2. Afnan Alhemeddi 3. Alanood Asiri 4. Anfal Ahshelawi 5. Ashwaq Asiri 6. Bashayer Almalki 7. Basma Alfaris 8. Bayan Alnooh 9. Hadeel Alsaif 10. Hayfa Alabdulkarim 11. Jumana Alshammari 12. Jumanah Alshenaifi 13. Lama Alshwairikh 14. Manar Aljebreen 15. Maria Alayed 16. Njoud Alfaisal 17. Nourah Alswaidan 18. Randa Bin Madhi 19. Rawan Alhayyan 20. Reema Alanezi 21. Sadeem Aldawwas 22. Samiha Aljetaily 23. Sara Alhaddab 24. Shatha Almweisheer 25. Tarfah Alobaidan 26. Walaa Alshehri If there is any concerns, please contact us at [email protected] 2 | P a g e Contents Obstetrics Anatomy + Placenta +Fetal circulation. ........................................................................................................ 5 Embryology of Female Genital Tract, Congenital Malformation & Intersex. ............................................. 17 Physiological Changes In Pregnancy. .......................................................................................................... 33 Physiology of menstrual cycle. .................................................................................................................... 41 Management of Labour. ............................................................................................................................. 50 Preterm Labour& Premature Rupture Of Membrane. ............................................................................... 60 Post Term + Induction of Labor. ................................................................................................................. 66 Bleeding in Early Pregnancy. ....................................................................................................................... 72 Ante Partum Haemorrhage. ........................................................................................................................ 86 Postpartum Haemorrhage. ......................................................................................................................... 94 Antenatal Care( Prenatal Care). ................................................................................................................ 105 Antepartum Intrapartum Fetal Monitoring. ............................................................................................. 108 Intra Uterine Growth Restriction (IUGR) + Intra Uterine Fetal Death (IUFD) ........................................... 115 Prenatal Testing ........................................................................................................................................ 122 Multiple pregnancy. .................................................................................................................................. 127 Diabetes Mellitus (DM). ............................................................................................................................ 136 Hypertensive disorders in Pregnancy. ...................................................................................................... 146 Cardiac Disease in Pregnancy. .................................................................................................................. 155 Anemia and Thyroid Diseases in Pregnancy ............................................................................................. 166 Urinary disease in pregnancy. ................................................................................................................... 178 Perinatal Infections. .................................................................................................................................. 183 Rh isoimmunisation, ABO Incompatibility ................................................................................................ 188 Puerperium& Puerperal Sepsis ................................................................................................................. 192 Some aspects in Neonatal Management .................................................................................................. 198 Gynecology Dysmenorrhoea, Premenstrual Syndrome & Endometriosis. .................................................................. 206 Amenorrhea. ............................................................................................................................................. 221 Abnormal Uterine Bleeding, Menorrhagia. .............................................................................................. 235 3 | P a g e PCO + Hirsutism. ....................................................................................................................................... 240 Infertility.................................................................................................................................................... 243 Genital Prolapse. ....................................................................................................................................... 250 Lower Genital tract infections + PID. ........................................................................................................ 255 Cervical Intraepithelial Lesion. .................................................................................................................. 265 Endometrial Neoplasm. ............................................................................................................................ 276 Gestational TrophblasticNeoplasia (GTN) ................................................................................................. 292 Ovarian Tumors ......................................................................................................................................... 300 Menopause & Postmenopausal Bleeding ................................................................................................. 312 Contraception. .......................................................................................................................................... 323 Patient Safety. ........................................................................................................................................... 336 4 | P a g e Anatomy + Placenta +Fetal circulation. Aims To fully understand the anatomy of the female pelvis in terms of bones and tissues, and fetal skull, this would help in explaining the mechanism of Labor To predict and thus prevent postpartumhemorrhage related to the placenta To understand the major events in fetal circulation; during pregnancy and after birth Objectives Student at the end of session should be able to: Explain the relationship between pelvic organs Comprehend the normal organs Understand the relationship between the female pelvis (Bones& Soft Tissue) and fetal skull, in order to understand the mechanism of labor Understand the major variant in the fetal circulation than that of the adult Know the significance of ductus venousus, ductus anteriousus and the first breath. Explain the changes that occur after birth. Familiarize yourself with the placental structure. Know the significance of placental and umbilical cord inspection after birth Differentiate between the different types of placental abnormalities and their significance Anatomy of the Female Pelvic Organs 1- Vulva External organs of the female include: Vaginal duct is very important b/c when the duct becomes 1-Mons veneris(Mons pubis) 2-Labia majora 3-Labia minora obstructed, the gland will become large and the woman 4-The clitoris 5-The vestibule will present with discomfort, but later on, the large gland The vestibule has six openings: will become inflamed then the woman will come to you 1-Urethral meatus2-Two skene’s ducts with pain! 3-Vaginal orifice4-Two Bartholin ducts. You must know the anatomy of the glands to differentiate Bartholin glands: them form any abnormal swellings. Lies on each side of the vagina, in the posterior lower third (1/3) of the interiotus. And in case of (episiotomy= a man made cut) you must Secrete mucus – alkaline know the anatomy of the vulva to know where to cut. -Pudendal artery from the femoral aa Blood supply -Venous drainage in the corresponding vein Lymphatic -Inguinal gland drainage -External iliac glands -Branches of the pudendal nerve, perineal nerve (T12 L1-2, S2-4) Nerves In labor: Catheterization, Episiotomy, Anesthetic infiltration If a woman comes to you in gyn/obstetric, you may end up with doing urethral catheterization to empty the bladder, so in labor, you have to know where is the urethral meatus to insert the cath. but not every woman in labor will end up with catheterization, but in gynecology, you must empty the bladder before starting any procedure. 2- Vagina A Canal/tube extend from the vulva to the uterus, runs upwards and backwards, and the walls lie in close contact, Speculum examination easily separated. The posterior vaginal wall is longer than the anterior 11.5 cm (4.5 in) vs 7.5 cm Cervix enters the vagina at a right angle. The vagina is closed , so you cannot inspect the Fornices:they are four 1Anterior, 1posterior,2lateral vagina except by using an instrument, which is Relatins: called (speculum). But you have to be careful when you insert the speculum and do not hurt the woman b/c if you hurt the woman, she will hate you and never come back to you! 5 |
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