OBGYN

  🩺 GYNECOLOGY AND OBSTETRICS NOTES (DETAILED POINT-WISE FORMAT)

---

 🔹 PART 1: EARLY PREGNANCY COMPLICATIONS

 ✅ Molar Pregnancy (Hydatidiform Mole)

 A type of gestational trophoblastic disease due to abnormal proliferation of trophoblastic tissue.

 Divided into:

   Complete mole: No fetal parts, 46XX (paternal origin), diffuse trophoblastic hyperplasia.

   Partial mole: Some fetal tissue present, triploid (69XXY), focal trophoblastic proliferation.

 Clinical signs:

   Vaginal bleeding during the first trimester.

   Uterus larger than expected for gestational age.

   Excessive nausea and vomiting (due to high β-hCG).

   Early onset preeclampsia (<20 weeks).

   Bilateral theca lutein cysts may be seen on ovaries.

 Investigations:

   Serum β-hCG is markedly elevated (>100,000 IU/L).

   Transvaginal ultrasound shows a snowstorm or cluster-of-grapes appearance.

 Management:

   Suction evacuation is the treatment of choice.

   Monitor β-hCG weekly until three consecutive negative results, then monthly for 6–12 months.

   Advise effective contraception during follow-up.

 ✅ Choriocarcinoma

 Malignant form of gestational trophoblastic neoplasia.

 Can follow molar pregnancy, normal pregnancy, abortion, or ectopic pregnancy.

 Presents with:

   Irregular vaginal bleeding.

   Extremely high β-hCG levels.

   Features of metastasis (lungs – cough/hemoptysis; brain – seizures).

 Diagnosis:

   No chorionic villi on histopathology.

   Positive pregnancy test.

   Imaging may show metastases (e.g., cannonball lesions in lungs).

 Management:

   Chemotherapy (e.g., Methotrexate or EMA-CO regimen).

   β-hCG monitoring until normalization.

 ✅ Ectopic Pregnancy

 Implantation of a fertilized ovum outside the uterine cavity.

 Most commonly occurs in the ampulla of the fallopian tube.

 Risk factors include PID, previous ectopic pregnancy, tubal surgery, IUCD use.

 Clinical features:

   Amenorrhea.

   Lower abdominal pain.

   Vaginal bleeding.

   Referred shoulder pain suggests rupture.

   Shock may occur in ruptured ectopic.

 Diagnosis:

   Serum β-hCG >1500 IU/L without intrauterine gestational sac on transvaginal ultrasound.

   Ultrasound may show adnexal mass or free fluid in the pouch of Douglas.

 Management:

   Medical: Methotrexate if stable and criteria met.

   Surgical: Laparoscopy or laparotomy (salpingectomy or salpingostomy).

 ✅ Types of Abortion

 Threatened abortion: Vaginal bleeding in early pregnancy with a closed cervical os; fetus is viable on ultrasound.

 Inevitable abortion: Bleeding with an open cervical os and no expulsion of products of conception (POC) yet.

 Incomplete abortion: Partial expulsion of POC, open cervical os, retained tissue seen on ultrasound.

 Complete abortion: Full expulsion of POC, closed os, empty uterus on ultrasound.

 Missed abortion: Fetus dies in utero but retained; no fetal heart activity, decreased pregnancy symptoms, retained POC.

---

 🔹 PART 2: ANTEPARTUM AND INTRAPARTUM COMPLICATIONS

 ✅ Placenta Previa

 Placenta is implanted in the lower uterine segment, possibly covering the internal os.

 Presents with painless, bright red vaginal bleeding in the third trimester.

 Uterus is non-tender.

 Diagnosed by transvaginal ultrasound (safe and most accurate).

 Managed by admission, monitoring, corticosteroids, and cesarean delivery at term.

 ✅ Abruptio Placentae

 Premature separation of a normally implanted placenta.

 Presents with painful bleeding, uterine tenderness, and a firm, rigid uterus.

 May have concealed hemorrhage (no visible bleeding).

 Risk factors include hypertension, trauma, smoking, cocaine use.

 Emergency management with stabilization and prompt delivery.

 ✅ Pre-eclampsia

 New-onset hypertension (≥140/90 mmHg) after 20 weeks with proteinuria (≥300 mg/day or +1 on dipstick).

 Symptoms include headache, visual disturbances, epigastric pain, edema.

 Severe preeclampsia includes BP ≥160/110, thrombocytopenia, elevated liver enzymes, or renal insufficiency.

 Managed with antihypertensives (labetalol, nifedipine), magnesium sulfate, and planned delivery.

 ✅ Eclampsia

 Preeclampsia complicated by seizures.

 Always rule out other causes of seizures.

 Treated with magnesium sulfate and delivery after stabilization.

 ✅ HELLP Syndrome

 Hemolysis, Elevated Liver enzymes, and Low Platelets.

 A severe form of preeclampsia.

 Presents with right upper quadrant pain, nausea, vomiting, and malaise.

 Managed with stabilization and urgent delivery.

 ✅ Gestational Diabetes Mellitus (GDM)

 Diagnosed by glucose challenge test (GCT) ≥140 mg/dL followed by an oral glucose tolerance test (OGTT).

 Associated with macrosomia, polyhydramnios, neonatal hypoglycemia.

 Managed with diet, insulin if needed, and regular fetal monitoring.

 ✅ Preterm Labor

 Labor occurring before 37 completed weeks.

 Risk factors include previous preterm birth, infection, short cervix.

 Fetal fibronectin test and cervical length help assess risk.

 Managed with tocolytics (nifedipine, indomethacin), corticosteroids for lung maturity, and magnesium sulfate for neuroprotection.

 ✅ PROM and PPROM

 Premature rupture of membranes (PROM): Rupture of membranes after 37 weeks, but before labor.

 Preterm PROM (PPROM): Rupture before 37 weeks.

 Confirmed with pooling of fluid, nitrazine test (turns blue), and ferning pattern on microscopy.

 PROM managed by induction; PPROM managed with antibiotics, corticosteroids, and monitoring.

---

 🔹 PART 3: GYNAECOLOGICAL CONDITIONS

 ✅ Polycystic Ovary Syndrome (PCOS)

 Diagnosed by Rotterdam criteria (2 of 3):

   Oligo/anovulation.

   Clinical or biochemical signs of hyperandrogenism.

   Polycystic ovaries on ultrasound.

 Clinical features:

   Hirsutism, acne, irregular cycles, infertility.

   USG: String of pearls appearance.

 Long-term risks: Type 2 DM, endometrial carcinoma.

 Managed with weight loss, OCPs, metformin, clomiphene for ovulation.

 ✅ Endometriosis

 Presence of endometrial glands and stroma outside the uterine cavity.

 Common sites: Ovary, pouch of Douglas, uterosacral ligaments.

 Presents with dysmenorrhea, dyspareunia, infertility.

 Ovarian involvement leads to chocolate cysts.

 Diagnosed via laparoscopy.

 Treated with NSAIDs, OCPs, GnRH analogs, or surgery.

 ✅ Fibroid Uterus (Leiomyoma)

 Benign smooth muscle tumor of the uterus.

 Symptoms include menorrhagia, pelvic mass, infertility.

 Uterus is firm, irregular, and enlarged.

 Diagnosed with ultrasound showing hypoechoic mass.

 Treated with hormonal therapy (GnRH agonists), myomectomy (fertility preservation), or hysterectomy.

 ✅ Adenomyosis

 Endometrial tissue present within the myometrium.

 Symptoms include dysmenorrhea and menorrhagia.

 Uterus is diffusely enlarged, boggy, and tender.

 MRI shows "venetian blind" appearance.

 Treated with NSAIDs, hormonal therapy, or hysterectomy.

 ✅ Cervical Cancer

 Presents with post-coital bleeding, foul vaginal discharge.

 Risk factors: Early sexual activity, multiple partners, HPV infection (types 16 and 18).

 Detected by abnormal Pap smear; confirmed with biopsy.

 Early stages treated surgically; advanced stages need chemoradiation.

 HPV vaccine is a preventive measure.

 ✅ Endometrial Cancer

 Most common gynecological malignancy.

 Presents with postmenopausal bleeding.

 Risk factors: Obesity, nulliparity, unopposed estrogen, PCOS.

 Diagnosis via transvaginal USG (endometrial thickness >4 mm) and endometrial biopsy.

 Treated with surgery ± radiotherapy.

 ✅ Ovarian Tumors

 Symptoms include abdominal distension, pain, early satiety.

 Benign types: Serous and mucinous cystadenomas.

 Malignant signs: Solid-cystic mass, ascites, bilateral involvement.

 Tumor markers: CA-125 (epithelial), AFP (yolk sac), β-hCG (choriocarcinoma), inhibin (granulosa).

 Specific tumors:

   Granulosa cell tumor: Call-Exner bodies, precocious puberty.

   Krukenberg tumor: Signet ring cells, metastasis from GI.

   Fibroma: Meigs’ syndrome (fibroma + ascites + pleural effusion).

---

 🔹 OTHER KEY GYNECOLOGICAL TOPICS

 ✅ Urinary Incontinence

 Stress incontinence: Leakage on coughing/sneezing due to weak pelvic floor.

 Urge incontinence: Sudden urge to urinate due to detrusor overactivity.

 Overflow incontinence: Continuous dribbling, due to incomplete emptying.

 ✅ Vaginal Infections

 Bacterial vaginosis: Thin white discharge, fishy odor, clue cells, pH >4.5.

 Candidiasis: Thick curdy discharge, intense itching, pseudohyphae.

 Trichomoniasis: Green frothy discharge, strawberry cervix, motile protozoa.

 ✅ Other Important Points

 Sheehan’s syndrome: Postpartum hypopituitarism; presents with failure to lactate and amenorrhea.

 Copper-T IUCD: Most effective emergency contraception.

 Combined oral contraceptives contraindicated in women with migraine with aura or uncontrolled hypertension.

 Hysterosalpingography (HSG): Best test to evaluate tubal patency.

 Tuberculosis of genital tract: Causes infertility, diagnosed by biopsy or HSG showing caseating granuloma.

---