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OBG update 1

ADIANA
FDA approved method of permanent contraception.
First a 60 sec radiofrequency thermal injury is done to the intramural portion of fallopian
tube.
Then a silicone elastomer is inserted into tubal lumen.
Aftwr 3 months hsg is required for confirming complete occlusion.

OBG UPDATE 2
For all of you cardiac output in pregnancy in detail at each week. So that you dont get
confused ever. Postpartum greater than late labor and second stage greater than 28-32
weeks.

OBG UPDATE 3
Return of hcg to undetectable levels after evacuation in molar pregnancy

Update 4 OBG
Lambda sign or twin peak sign
Seen in dichorionic twins

Update 5 OBG
TODAY VAGINAL SPONGE.
when in position the sponge dimple apposes the cervix surface, and the ribbon loop faces
outward to allow easy hooking with a finger for removal.

Update 6 OBG
Primordial germ ells are derivatives of Epiblast Ref: Pg. 13, Langman Embryology (Ed 11th),
Pg. 186, Grays Anatomy (Ed 40th)Primordial germ (PGCs) cells have been isolated from the
epiblast at the posterior end of primitive streak in 2nd week.Germ layers form in the 3rd week
by the process of gastrulation.Hence, PGCs cannot be considered as a derivative of any
embryonic germ layers.Though some investigators consider epiblast as primitive ectoderm,
hence, ectoderm can be a choice as answer, if epiblast was not among the options.Earlier it
was believed that the primordial germ cells are derived from the endoderm of yolk sac wall,
but now it is established that they are derivative of the epiblast cells, they migrate through the
yolk sac wall, and the mesentery of hindgut to reach the genital ridge.
OBGY update 7
williams table showing amniotic ffluid levels
second graph also from williams showing the steady decline in amniotic fluid afyer 28-32
weeks by 3 different workers

UPDATE 9 OBGY
For those who just want to mug up guides and challenge what we teach in class.
The first para is page 404 and second para page 407 leon speroff. The first change at
puberty is growth spurt!!!

UPDATE 10 OBGY
A common mistake to the question - predominant estrogen produced by placenta at term.
invariably you all answer estriol which is wrong. correct answer is estradiol.

UPDATE 11 OBGY
gonadal dysgenesis and ambiguous genitalia has been one of the repeated topics in AIIMS
exam. Turners syndrome is the first of these i am updating about.

UPDATE 12 OBGY
Second important topic from sexual differentiation.
please note this is how we define mullerian agenesis or rokitansky syndrome- characterized
by absence of vagina absent or hypoplastic uterus and normal or hypoplastic fallopian tube.
whereas in AIS there is a blind ending or short vagina.

UPDATE 13 OBGY
NEW 2013 WHO GUIDELINES FOR ART IN HIV
The new recommendations encourage all countries to initiate treatment in adults living with
HIV when their CD4 cell count falls to 500 cells/mm or less when their immune systems are
still strong. The previous WHO recommendation, set in 2010, was to offer treatment at 350
CD4 cells/mm or less. 90% of all countries have adopted the 2010 recommendation. A few,
such as Algeria, Argentina and Brazil, are already offering treatment at 500 cells/mm3.
The new recommendations also include providing antiretroviral therapy - irrespective of their
CD4 count - to all children with HIV under 5 years of age, all pregnant and breastfeeding
women with HIV, and to all HIV-positive partners where one partner in the relationship is
uninfected. The Organization continues to recommend that all people with HIV with active
tuberculosis or with hepatitis B disease receive antiretroviral therapy.
Another new recommendation is to offer all adults starting to take ART the same daily single
fixed-dose combination pill. This combination is easier to take and safer than alternative
combinations previously recommended and can be used in adults, pregnant women,
adolescents and older children.
The recommended treatment is now a combination of three antiretroviral drugs: tenofovir and
lamivudine (or emtricitabine) and efavirenz, as a single pill, given once daily.
UPDATE.14 OBGY
order of appearance of germ layers is endoderm then mesoderm and then ectoderm.
UPDATE 15 OBGY
AMERICAN BRACHYTHERAPY SOCIETY GUIDELINES (ABS) for cancer cervix
On popular demand
AIIMS high risk question
point A early stage 80-85 Gy
advanced stage 85-90Gy

Pelvic side wall


early stage 50-55Gy
advanced stage 55-60Gy
Absolute dose for rectum less than 75Gy and for bladder less than 80Gy
UPDATE 16 OBGY
Rh negative pregnancy
high yield points
1) most common hemolytic disease in newborn is A,B incompatability
2) C,D,E antigens are located on short arm of chromosome 1
3 ) lewis system does not cause hemolysis
4) immune hydrops - fluid collects in thorax abdominal cavity and skin
5) mirror syndrome when rh negative sensitized mother develops pre eclampsia. she
resembles the hydropic baby.
6)ICT critical titre is 1:16
7) MCA peak systolic velocity more than 1.5MoM cirresponds to mod to severe fetal anemia
8) on liley curve zone 2 upper half indicates hb between 8-10.9
lower half hb is between 11-13.9
9) on liley curve zone 3 means hb less than 8gm %
10) intrauterine transfusion is done when fetal hematocrit less than 30%
11) 300micro gm od anti d is given to the mother within 72 hrs of delivery if fetus is rh positive.
12) dose of anti d after firts trimester abortion is 50 micogram
and after 12 weeks it is 300mcg
13) 300mcg anti d protects against 30ml fetal blood and 15ml fetal rbc
14) dose of anti d is calculated by KB test based on that fetal red cells are resistant to acid
denturation
15) maternal to fetal hge resulting in isoimmunization is called as grandmother theory.
UPDATE 17 OBGY
Definition of precipitate labour for some of you who read guides. page 470 williams 23rd
edition.

UPDATE 18 OBGY
POST MENOPAUSAL HORMONE THERAPY
CVS both E and E+P are protective for cvs. The protective effect is more with E alone.
But even then it is not given for primary prevention of CAD.
Postmenopausal HRT increases risk of VTE. But most cases occur in first 2 yrs of
exposure and in women more than 70yrs and who are obese.

Breat cancer. current postmenopausal HRT increases risk breast cancer. the risk is more
with E+P than E alone. But the cancer that occur after hrt are seen to be better
differentiated.
Endometrial cancer. E alone or umopposed E is a risk factor once progesterone is added
then it does not increase risk of endometrial cancer.
The minimum no of days at which progesterone has protective effect is 12-14 days in a
month.
ovarian cancer. risk is increased with both E alone and E+ P
colorectal cancer. risk is reduced with both E and E + P
diabetes mellitus Both E and E+P improve gluocse tolerance
dementia- both E and E+P increase the risk of dementiain women older than 65 yrs
HRT reduces the prevelence and severity of osteoarthritis at hip joint. But it is not first line
therapy for same.
UPDATE 19 OBGY
IOCs for various conditions
fibroid - USG
tubal payency- HSG
Mullerian anomalies - MRI
Endometriosis - Laproscopy
post coital bleeding - PAPS
post menopausal bleeding endometrial biopsy
pid - USG
adenexal mass - USG
amenorrhoea - hormonal asessment
molar - USG
Ectopic - TVS
ovulation - follicular monitoring
hirsutism with menstrual irregularity- -serum testosterone
AUB USG
Adenomyosis - MRI
ovarian reserve - FSH
VVF - Cystoscopy
UPDATE 20 OBGY
RisK of progression and regression in CIN Lesions
10% of LSIL progress to HSIL
10% of HSIL Progress to invasive carcinoma.

average time taken by CIN 3 to progress to malignancy is 5-10 yrs

UPDATE 21 OBGY
COLPOSCOPE AIPG update( recent question)
invented by Hinselmann in 1925
it has a focal length of 30cm
colposcope has a magnification 9f 10-30 times
colpomicroscope has a magnification of 100-300 times
it has a green filter

UPDATE 22 OBGY
PUBERTY
Puberty is marked by beginning of nocturnal pulse sectetion of GnRH which causes increase
in LH Hormone pulse amplitude
Factors which promote GnRH pulsatile release at puberty are
1) decrease in GABA
2) decrease in neuropepetide Y
3) increase in glutamate
4) increase in kisspeptin
5) increase in leptin( which is related to body weight)
increase in GnRH causes increase in basal estradiol and Inhibin B while inhibin A lwvels
remain low
GnRH is released fron arcuate nucleus in medial hypothalamus
neurons that synthesize GnRH originate from olfactory placode
hypothalamic piuitary venous system development in fetus begins by 9-10 weeks and
completed by 19 -20 weeks of pog
pituitary LH FSH secretion in fetus begins at 12 weeks and peaks at 20 weeks of pog.

UPDATE 23 OBGY
The epididymis is divided into following segments, the initial segement the caput where the
sperm begin their process of maturation, the corpus where maturation continues and cauda
the site of final matutation and storage.
SO MATURATION OF SPERM OCCURS IN EPIDIDYMIS not female genital tract.
page 244 leon speroff.
UPDATE 24 OBGY
Persona consists of a small hand held Monitor,which is a mini-computer, and disposable urine
Test Sticks.
You sample your morning urine on the Test Stick (for 16 days the first month, and for 8 days in
subsequent months).

The Test Stick collects 2 hormones in the urine and converts their levels into a form that can
be read by the Monitor.
Then you insert the Test Stick into a special slot on the Monitor.
The Monitor reads and analyzes the Test Stick, it learns about your unique cycle profile, and it
displays birth control and cycle advice every day.
The Monitor tells you when you need to test, when you can have sex (Infertile days), when
you should abstain from sex or use a barrier method (Fertile days), and when you're about to
start your menstrual period.
The Monitor displays:
Ayellow light when test is needed
A red light on fertile days
A green light for infertile days
UPDATE 25 OBGY
MAGNESIUM SULPHATE
1) is not given to treat hypertension , it is given as anticonvulsant
2) anticonvulsant action is on cerebral cortex
3)main action is blockade of NMDA receptors in brain
4)if not controlled with mgso4 then supplementary medication is amobarbital or thiopental
given iv slowly
5)at the dose given for eclampsia it does not inhibit uterine contractions. levels needed to
inhibit uterine contractions is 8-10 meq/l
6) it also has neuroprotective fetal effects in preterm babies.

UPDATE 26 OBGY
CLASP TRIAL, ABSTRACT
In our multicentre study 9364 women were randomly assigned 60 mg aspirin daily or
matching placebo
74% were entered for prophylaxis of pre-eclampsia, 12% for prophylaxis of IUGR, 12% for
treatment of pre-eclampsia, and 3% for treatment of IUGR.
Overall, the use of aspirin was associated with a reduction of only 12% in the incidence of
proteinuric pre-eclampsia, which was not significant. Nor was there any significant effect on
the incidence of IUGR or of stillbirth and neonatal death.
Aspirin did, however, significantly reduce the likelihood of preterm delivery (19.7% aspirin vs
22.2% control; absolute reduction of 2.5 [SD 0.9] per 100 women treated; 2p = 0.003). There
was a significant trend (p = 0.004) towards progressively greater reductions in proteinuric preeclampsia the more preterm the delivery.
Aspirin was not associated with a significant increase in placental haemorrhages or in
bleeding during preparation for epidural anaesthesia, but there was a slight increase in use of
blood transfusion after delivery.
Low-dose aspirin was generally safe for the fetus and newborn infant, with no evidence of an
increased likelihood of bleeding.

Our findings do not support routine prophylactic or therapeutic administration of antiplatelet


therapy in pregnancy to all women at increased risk of pre-eclampsia or IUGR. Low-dose
aspirin may be justified in women judged to be especially liable to early-onset pre-eclampsia
severe enough to need very preterm delivery. In such women it seems appropriate to start
low-dose aspirin prophylactically early in the second trimester.
UPDATE 27 OBGY
PCOD AND METABOLIC SYNDROME
Insulin lowering agents may be given when these criteria are present
1) waist > 35 inches
2) TG > 150mg/dl
3) HDL < 50mg/dl
4) BP> 130/85
5) Fasting glucose 110-125mg/dl
6) 2hr gtt 140-199mg/dl
UPDATE 28 OBGY
SOFT SIGNS OF DOWNS SYNDROME SEEN IN 2ND TRIMESTER USG

UPDATE 29 OBGY
DOWNS C9CONTINUED
VALUES OF MARKERS USED
First trimester serum screening done from 11-14 weeks
second trimester serum screening done betweeb 15 -20 weeks

hCG 2 MoM
PAPPA 0.4 MoM
AFP 0.7 MoM
unconjugated estriol 0.8 MoM
Inhibin A 1.8 MoM
cut off for NT IS 3.5mm
Amniocentesis done between 15-20 weeks
CVS done between 10-13 weeks
NT Done between 11 -13+6weeks

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