Sureshot 5.0 by Dr.

Nikita
12/10/23

MATERNAL PELVIS & FETAL SKULL

M/C —————->

Three presentations are :

VERTEX —> SubOccipito / Occipito
FACE —> Submento
BROW (Max Diameter) —> Mentovertical Diameter (Remember as BMV/ BMW)

FACE presentation = Complete Extension

Completely Flexed Vertex : SOB —> SOF —> OF

9.5 10 11.5

Most Favourable Pelvis = Gynecoid 13

Transverse Least Favourable = Android / Male Pelvis
Rounded circle (Deep transverse Arrest is Common)

OBGY

Heart
Shaped

AP > Transverse Diameter = Vertical Oval

Face to Pubis

Tricks to remember :

• Pelvis cavity = Circle—> All equal Diameter (AP/O/T) —> 12 cm

• Oblique = Oval —> 12 cm
• Outlet = Diamond (AP > Trans = 13>11)
• Inlet = Opposite (Trans > AP = 13>11) : Engagement takes place at Transverse Diameter, Outlet is AP > Trans)
Hence 90 degree rotation takes place

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12/10/23

1) Naegele (1 Sacral ala Absent) 2) Robert (Both Sacral Ala Absent)

T
O Minimum : Obstetric Conjugate
D

True : 11
Obst : 10
Diagonal : 12/11.5
OC = DC - 1.5 cm

IBQ : Diagonal Conjugate /

Clinical Conjugate
Measurement

E T PI PRE NAN
Relative Contraindications for Mtx • Single = 50
50mg/IM,
mg/m IM D7 2nd Dose
2

• Multiple = 1mg/kg in D1357

13 • Sac
Sac size> >3 ____cm
Size to 4 cm + Leucovorin D2,4,6,8
• FCA
FCA+ _______
• Beta
Beta- HCG
hCG >levels
3000_______ iu/l/L
- 5000 IU
Absolute contraindication
Ring of Fire Sign
• Intrauterine
IntrauterinePregnancy
pregnancy
OBGY

USG sign -
PseudoGSac Ring of Fire Sign

Most common 1. Site

Site=-Ampulla
- 2. Rupture
Rupturesite
site=-Isthmus
3. Risk
RiskFactor
factor =- PID
Management Conservative
Conservative Surgical
Surgical

• MTX • Ruptured
• >4cm
• KCl • >5000
• Actinomycin • Live
• Anti-D

22

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 Sureshot 5.0 by Dr. Nikita

Ectopic Pregnancy. Outside Uterus

Tube MC. Ampulla
LC Interstitium

Max risk. Previous tubal surgery

MC risk PID (very common)

MC Easiest. Isthmus (narrowest)

Rupture

Late Interstitium. Supp by myometrium

Susp ectopic

Unstable
Stable

USG. TVS Stabilise Laparotomy

empty uterus
Pseudogestational sac. Fluid, Central,
Adnexal sac(Tubal ring Doppler sign)

Yolk sac= Intra uterine pregnancy

If USG -ve: serum BHCG. >2000. Ectopic
If C1500
Doubling
Present Absent Failed
IUP not doubled
Ectopic
In ectopic
- BHCG low
- doubling time high

Mx
FCA absent Expectant: If BHCG falls, pt understands, BHCG<1500,
Unruptured

In sac KCl
Medical: MTX Actinomysin
Ruptured. Blood. POD. fluid USG
BHCG < 3000/5000 Systemic
Sac < 3-4 cm
Single
Shoulder pain 13
Multi
Hx. Shock. High shock
50mg/m 5
Day 1,3,4,7 BP <90. Unstable
BHCG <15% Synapse
Synapse
Syncope

Stabilise fast. Laparotomy

Ruptured Sx Anti D OBGY
Definitive salpingectomy
<12 wk >12 wk If fertility preserved Salpingostomy
Salpingectomy
50 mug 300 mug
Follow up with
after
BHCG
B HCG fallsfall
should

Hetrotropic
Heterotrophic
Heterotopic pregnancy. Intrauterine + Extrauterine

XX MTX

Mx SURGICAL

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 Sureshot 5.0 by Dr. Nikita
12/10/23

Ectopic pregnancy criteria

Cannula. Cervix. (Cervical)

Sperm. Ova. Ovarian
Abdominal

13
OBGY

LA-DDU (Lambda in DCDA pregnancy) Mo-Di (Monochorionic Diamniotic)

Separn early
Twin peak sign
<3d >13 d
Lambda
Thick > 2mm DCDA MCDA MCMA Conjoint

Max complication. Monochorionic

Monoamniotic

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12/10/23

E E
Favourable for induction.

C= Consistency
P= Position
Cervix Nothing related to maternal pelvis
E= Effacement
D= Dilatation
S= Station Fetal head

Mod: cervical length instead of effacement

Condition Causes Initial. transudate

Maternal tranusudate
Duodenal atresia Espoph atresia Polyhydroamnios
Fetal skin 13
Renal agenesis Clubbed feet
20wks. Fetal urine Oligohydroamnios. Renal urine
(Potter sequence) outflow obst
Maternal DM Polyhydroamnios Fetal hyperglycaemia
No nutrition. Predom water
Isoimmunization Polydramnios
Anencephaly CSF seeping. Polyhydroamnios
OBGY
Uteroplacental Eg: Preeclampsia. Oligohydroamnios
Swallowing problem. AFI
Polyhydroamnios
insufficiency Cleft palate
• Maximum amniotic fluid is at _________
34 weeks
ec
McConium stain. Green
Rh Incompatibility. Hemolysis. Bilirubin. Golden yellow Oligo Poly Amnioreduction mx
SDP<2cm SDP > 8cm
AFI < 5 AFI > 25

>2L

22

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 Sureshot 5.0 by Dr. Nikita
12/10/23

a rip e a r pe ar er e t
Dual. First trimester

Beta PAPPA
PapA

Triple

UE3 Triol (predominant)

Not in triple
A= Allowed
B = Banned

Downs: HCG, Inhibin A are increased (HI are high)

Rest are decreased

Edward. Everything Decreased

13
OBGY

Early deceleration HE
6 Terminate
Late deceleration LP

Variable deceleration VC
CTG

VC deceleration. HELP
Sine wave pattern: Fetal anemia
Variable Head Late Mx Terminate pregnancy
Cord comp Early Placental

Gradual Steep

22

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12/10/23
C110. Brady
1) Antepartum period. NST. FHR Beat to beat variability

FHR acceleration
2) Intrapartum. CTG. Cardiotocography
FHR , contraction

Steep

Acute stress. FHR 3) Biophysical profile

4) Modified BPP Breathing
Amniotic Fluid
Tone
Chronic stress. AFI Movement of fetus
NST/Fine

E
GTD
13
Molar Non molar
-villi present -villi absent
Choriocarcinoma(MC) Metastasis +
PSTT
Benign Epitheloid
Malig
Partial.
Invasive
Triploid
Fetal parts
Complete OBGY
Non metastatic Malignant:
no Fetal part
HCG Ovaries BHCG even after S/E
Theca Lutein cyst Monitor BHCG after evacuation till -ve
(In twins)also • GTN risk Within 48 hrs Boeline
Baseline Weekly till -ve. Monthly
Non GTN
Vesicles USG. snowstorm appearance
For 6m & 12m
(Molar) Malig. Chemotherapy
CF : BHCG. 1) Hyperemesis gravidara
2) Inc ut size
S/O malignant. Persistent/ Inc BHCG
UPT False -ve 3) PV bleed 1st trim. grape like vesicles
4) Thyrotoxicosis (HCG mimics TSH) Persist TLC inc size (not number)
5) Preeclampsia. Antiangiogenic factors Metastasis — suburethral nodule
Stages Canon ball mets - Stage 3
1 Uterus
Mgmt: Suction evacuation irresp of uterine size
2 genital adnexa/vagina(suburethral nodules)
Theco LC HCG gore. Spontaneous resolution in 2 months
3 lungs
If not. S/o. GTN
4 others
Symptomatic Aspiration
Twisting. Untwisting/oopherectomy (ext necrosis/haemorrhage)
Contraception. No IUD. Bleed/Perforation
WHO Risk score
Treatment
Trmt: 22
>6 EMACO (High risk)
:Single drug Methotrexate
< 6 Mtx (low risk)
Multi EMACO

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12/10/23

E E E
>24 weeks of pregnancy (RCOG)
> 28 weeks (India)

USG TAS
first: Whether placenta is low lying
TVS next as it gives better images of
margin of placenta

Placenta Previa: MC for transverse lie of fetus

I. Low lying (< 2cm)
II. Marginal (touching)
III. Partial/ Incomplete. PP:
LSCS if in labour/ >37 weeks
IV. Complete/ Central
Conservative McCafee regimen
C/F Sudden painless bleeding. Night during sleep In hospital <34 weeks
Uterus. POG. US
Vs. abruptis,
o hence Hx+ sizeUterus
concealed
Concealed size
is more) Abruptio:
corresponding more If DIC/Shock/Fetal distress Delivery
No tocolytics
Abruptio If stable. Conservative in hosp mgmt
painful Page classfn (torn placenta)
Uterus > POG H/o trauma
PP Vasa previa Preeclampsia high risk factor
(Concealed) Uterine rupture
painless Fetal bleed
APT test H/O LSCS
DIC. Thromboplastin
Couvelaire/uterine apoplexy Velamentous Contraction stop
(Concealed) Not an indication for Foetal distress Well felt
hysterectomy >
-

tetric ane er
Best for aftercoming head:
Pipers Forceps
13
Sharva

Shoulder dystonia Popliteal pinard t Burns Marshall

Wigord margin
e
Breach
Breech
OBGY

Breech. Arm MSV

Lovsets

Prague: Chin to pubis

offset

22

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Sureshot 5.0 by Dr. Nikita 12/10/23

Shoulder dystosia
c

Impacted

Rubins
Unimpacted

Mc Roberts Wood corkscrew

Zavanelli

Meralgia paresthetica Craskin

G

E E E
Foot end

13

OBGY

Pawlik. 3rd

Ritgen Controlled delivery of head

Perineal tear

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 Sureshot 5.0 by Dr. Nikita
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agina in ection

Thin yellow Green Curdy thick

Not
<4.5

(Fishy)

Metro/Clinda meTRo Flucanazole

1) Bacterial. A. B. C
Altered flora Clue
No inflammation
No WBCs
Amsels Backt Cells
No itch criteria vag
Metro/clinda

No itch, fishy smell

13
OBGY

2) Trichomonas: sTRawberry
meTRonidazole
TRophozoite only, no cyst
TReat partner also, STI

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Sureshot 5.0 by Dr. Nikita 12/10/23

Ovarian tumors classification

I. Common epithelial tumors III. Germ cell tumors:
• Serous tumors D
Oysgerminoma
• Mucinous tumors Endodermal sinus tumor (Yolk sac tumor)
• Endometnoid tumors Embryonal carcinoma
• Clear cell Polyembryoma
• Brenner tumors (transitional cell tumors) Non-gestational chonocarctnoma
Choriocarcinoma
• Seromucinous Undifferentiated carcinoma
Teratoma (Mature/immature)
II. Sex cord-stromal tumors:
• Pure stromal cell tumors- Fibroma. Thecoma. Leydig cell Mixed forms
tumor. Steroid
Sertoli cell tumor IV. Gonadoblastoma
• Pure sex cord tumors- Granulosa cell tumor (Adult/Juvenile). • Pure
Sena cell tumor • Mixed with dysgerminoma or other germ cell
• mixed sex cord-stromal tumors- Sertoli-Leydig cell tumors tumors

V. Soft tissue tumors not specific to ovary

VI. Miscellaneous tumors
VII. Secondary (metastatic) tumors
VIII. Tumor-like conditions

• Yolk Sac Tumor : They are also called Endodermal Sinus Tumor
The bodies seen are Schillar Duval Bodies, As it looks like a Glomerulus (YES —> G)

T Serous 13

OBGY

t
• GERM Cell —> Alpha fetoprotein
• Dysgerminoma —> DPL —> PLAP, LDH
• Granulosa Cell tumour —> CD99 / mic 2
(Call-Exner Bodies, Coffee bean nucleus, Pseudorosette, Inhibin B)
• Chorio Carcinoma —> HCG

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 Sureshot 5.0 by Dr. Nikita
12/10/23

Glomeruloid body = / Schiller Duval body

Call Exner bodies Yolk sac tumor

Psammoma body
Reinke
Crystal

Walthord
Cell nest

Signet ring
Krukenberg

Hobnail cell Clear cell tumor

NTRA EPTI N
13
OBGY

CuT 380A • LNG

• 52 mg Multiload 375A Nova T
• releases 20 micro gram/day

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• Chhaya
• Centchroman
• Non-steroidal

IMP IMA ES
13

OBGY

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 Sureshot 5.0 by Dr. Nikita
12/10/23

PCOS Velamentous placenta

Unicornuate uterus

Asherman Syndrome
Uterine Sound

13

• Endometriosis
Outlet forceps
Gold Std Ix Laparoscopy • Ca Cervix with
OBGY

HN/HU =
C/F Dysmenorrhea
Stage 3B
Dyspareunia
Rx = CTRT

• Powder burn lesions

• Chocolate cyst ovary
• Adhesions +

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