Ultrasound

showing uterus
and tubal
pregnancy

 Same image.
Uterus outlined
in red, uterine
lining in green,
ectopic
pregnancy
yellow. Fluid in
uterus at blue
circle sometimes
called a
"pseudosac"

 Tx: laparatomy or laparascopic

salphyngotomy or salphyngectomy

MOLAR PREGNANCY
Can be divide into:
Complete mole
Partial mole

Dx:
Hx and examination
Blood Ix : FBC, LFT, TFT, coagulation profile, B hCG
U/S : snowstorm appearance or bunch of grape
: small vesicles and areas of hemorrhage
CXR
Tx : suction and curettage

x
x
x

x x

x
x

There is a
tapering of
growth.
asymmetrically
smaller than
gestational age.
H/A is increased

2. Asymmetrical HC/AC INCREASED

-Brain sparring due to placenta blood
flow compromise
-Causes: placental insufficiency,
severe maternal dis. Renal
dis.idiopathic

x
x

Fetus growing on
the 5th percentile

Symmetrically
smaller than
gestational age

x
x

H/A is normal

x
x

Intrauterine Growth Restriction

-A fetus measured below the 10th percentile of
weight for gestational age
-1. Symmetrical ( HC/AC normal)
- proportionate reduction of all fetal
parameters.
- prior to 26 weeks persisting until
delivery
- idiopathic( 90%)
-chrom.abnormality, TORCH,heavy
smoking, fetal alcoho
synd.undernutrition

NORMAL DOPPLER ULTRASOUND

ABSENT DIASTOLIC FLOW

REVERSE DIASTOLIC FLOW

Doppler Ultrasound
Umbilical artery Doppler:
Measuring the umbilical S/D ratio
Indicator for vascular resistance in placenta
Elevated S/D ratio indicates increase resistance
Absent/reversed diastolic flow indicates extremely
high resistance in placental bed and associated with
poor prognosis

MALIGNANCY
USG features:

Bilateral
Size
Solid (or mixture)
Indeterminate border
Thickened capsule
wall
Breech capsule
Multiseptae
Papillary projection

Presence of ascites
Doppler
Increased vascularity

Ovarian Ca
90% epithelial tumour
papillary serous cystadenoca, mucinous
cystadenoca, endometroid cystadenoca
Tx : surgery and chemotherapy

PCOS
Presence of triad:
Hyperandrogenism
Disorder of menses
Subfertility

USG features:
String of pearl
necklace
Dense ovarian stroma

Ix:
Serum LH & FSH (23:1)
Elevated androgen
(testosterone and
androstenedione)
Ele serum insulin

Tx:
Anti-oetrogen:
clomiphen or tamoxifen

Spatula

 Ayers spatula
For cervical cytology/ papanicolou smear
a. ectocervix smear
B. fornix smear
CIx: during mensus, sex within 24 hrs before the
test, no consent, virgin
Histology finding: (Bethesda sys)
Dyskaryotic: hyperchromasia / large nuclear to
cytoplasmic ratio
Increase mitotic cells

 Gonadotrophine releasing hormon

analogue/agonist (GnRH) / Zoladex
Indication: pseudomenopause=
endometriosis and fibroid
Side effects: hirsutism, hourseness of
voice, bone loss, hot flush, night sweat

IUCD

 Intrauterine contraceptive device

action:
1.induced an inflammatory response in the
endomtrium that prevents implantation
2. Toxic effect on sperm to prevent fertilization
3. Thicken cervical mucus and endometrium
(hormon)
SE: PID, increase menstrual loss, dysmenorrhoea.
: acne, breast tenderness, wt gain, spotting &
irregular bleeding (hormon)

OSCE 4 Depo provera

 Injectable progestogen / Medroxyprogesterone

acetate
IM
SE: wt gain, irregular mensus, delay in returning
fertility,others
Indication: PMS, painful period, cannot
remember to take pill
Action: inhibit ovulation, thicken cervical mucus,
reduce development of endometrium (thin and
atrophy)

MgSO4

 Magnesium sulphate
prevention of fits in a woman with preeclampsia
or who has had eclampsia
Toxic effect (maternal) : respiratory depression,
cardiorespiratory arrest, hypotension
Earliest sign of toxicity : Loss of tendon reflexes
Neonatal hazard : Respiratory depression,
hypotonia, hypotension

Pessaries

 Pessary (ring, Hodge, shelf)

Indication: uterovaginal prolapse, pts
wish, not fit for surg, child bearing not
complete, awaiting surg
SE: vaginal ulcer, v discahrge, bleeding,
discomfort, infection malignant change,
Chnge 1 or 2 a year

Hormone

A. LH
B. FSH?
C. progesterone
D. estrogen
E. inhibin

 Flisher clip
(female sterilization)
Cx : rupture, perforation, high risk of ectopic
pregnancy
Other alternative: falope ring, diathermy,
vasectomy
Advantages :
Laparoscopic procedure less invasive
Low failure rate
Reversib;e

Tetanium

A. What are these instruments for? (1 mark)

B. What is the aim of this procedures (2
marks)
C. Name the instrument label A (2 marks)
D. Describe the procedures of concerned (5
marks)

Fetal scalp PH instrument

To discover whether an abnormal FHR is due to fetal hypoxia and
to prevent severe asphysia
Amnioscopes
Pt is place on Lt lateral or lithotomy
Sterile tech. Appropriate size of amnioscope is inserted through
the cervix up against fetal scalp/breech.
Light source is attached. The presenting part is cleaned and
smear with silicone jelly.
Ethyl chloride is spray for 10 sec to produce hyperaemia.
Scalp/ buttock is stabbed once with guarded blade.
A continous column of blood (10-30 ul ) free of bubble of air is
collected in capillary tube.
Pressure is applied to secure bleeding.

OSCE 8

Name the
instrument shown
What is the use of
this instrument
Briefly describe the
applications of this
instrument
List four possible
complications
associated with
application of this
instrument

 metal cup
Vacuum delivery during 2nd stage of labour
ant 2/3 of the posterior frontanel, as post
as possible, not cover the frontanel and
suture, head at +1 or +2 station.
Tissue entrapment, laceration (M)
Heamatoma, intracranial bleed(F)

 Simpson-Neville-Barnes forcep
Prerequisity: inform consent, head
engaged, cx fully dilated, suitable
presenting part(vertex), empty bladder,
suitable anesthesia.
Cx: perineal tear, tissue entrapment,PPH
Bruise mark, nerve palsy, skull #

twin

hyperstimulation

 Excessive oxytocin
Stop oxytocin infusion, give O2, hydration

 Late deceleration
Causes(M): plc abruptio, mt hpotension,
excessive uterine act, DM, PIH, renal
disease
(F): IUGR, prematurity, tw-to-tw
transfution, rh isoimmunisation
Change mt posture, increase iv infution,
O2, stop oxytocin, fetal blood smpling,
prepare for delivery.

 Prolonged deceleration
Cord prolapse, mt hypotension (epidural
or local anaesthesia, uterine hypertonia
Change mt posture, fluid, stop oxytocin,
O2, VE for cord prolapse, check BP,
prepare for delivery.

 Endometriosis
Clinical features: dysmenorrhoea,
menorrhagia, subfertility.
Comfirm dx: laparoscopic examination
tx.: med COCP, Mefenamic acid, GNRH
analogue
Sug: laser, adhesiolysis, diatomy

D & C set

 Ovum forcep take out POC

Uterine sound measure length & position of
uterus
Sharp currate to scrap the endometrium (ant,
post, lateral n fundus wall)
Varselum teale hold and pull cervix
Sim speculum to visualize (by dr marion sims)
Hegar dilator to dilate cervix (3mm 18mm)

hysteroscope

Pipelle

Name : pipelle de cornier

For endometrial sampling
Other alternatives ix: d&c , hysteroscopy
Advantages ;
Can be conducted in outpatient setting
Cheaper
No anaesthesia required
Require minimal expertise

Hysterogram