GYNAECOLOGY AND OBSTETRICS mci screening test and indian medical pg examz high yield important topics study tips

By Live Dr - Wed Feb 11, 3:45 am


6-13 -favourable

5 or less is unfavourable

FETAL HEART RATE deceleration type causes
Early deceleration Head compression
Late deceleration Placental insufficiency, PIH, fetal distress
Variable deceleration Cord compression

*Baseline variability with or without periodic acceleration of the fetal heart rate is a sign of fetal well being

Increasing baseline variability (salutatory pattern) represents early compromise of fetal oxygenation

*Bpd is the single best parameter for estimation of fetal age in second trimester

Femur length is the single best parameter for estimation of fetal age in third trimester

Diagnostic criteria of PIH

Hypertension An absolute rise of blood pressure of atleast 140/90 mm of Hg,

Or a rise in systolic blood pressure of atleast 30 mm of Hg, or arise in diastolic pressure of atleast 15 mm of Hg, over the previously known blood pressure

A rise of 20 mm of Hg MAP over the previous reading,

Or when the MAP is 105 mm of Hg, or more.

The rise of blood pressure should be evident at least on two occasions, atleast 4 hours apart

Edema Pitting edema over the ankles, after 12 hours of bed rest

Or rapid gain of weight of more than 1 pound/week, or more than 5 pound a month

Proteinuria Protein in 24 hours urine, of more than 0.3 gm or more than 1 gm per litre, in  2 or more midstream specimens, obtained 6 hours apart,  in the absence of UTI


It does not matter how slowly you go so long as you do not stop.- Confucius

ELEVENTH HOUR GYNECOLOGY & OBSTETRICS                                                                             128

Pritchard’s regime

Magnesium sulphate- 4 gm IV and 10 gm deep IM 5 gm, in alternate buttocks 4 hourly.

Repeat injection only after checking-

Urine output is more than 30 ml/ hour

Respiration rate is > 12 / minute

Knee jerk is present.

Therapeutic level of serum magnesium is 4-7 meq/l

Treatment is to be stopped 24 hours after the last seizure

*HELLP syndrome

A complication of pih.


Elevated Liver enzymes

Low Platelet count.

*Prognostic factor of PIH

Blood uric acid level > 3.6 mg/dl, suggestive of bad prognosis

Hasse’s rule

Calculating age of fetus

During first 5 months During next 5 months
Length in cm is square of the age in lunar months Length in cm is 5 times the age in lunar months

WHO criteria for diagnosis of gestational diabetes mellitus

Time Normal values Impaired tolerance Diabetes
Fasting <105 105-139 140 or more
2 hours post glucose < 160 160-199 200 or more

Classification of gestational diabetics

a Gestational diabetics
b Overt diabetics without vasculopathy
c Diabetics with vasculopathy
Effects of diabetes on mother Effects of pregnancy on diabetes


Postpartum bleeding

More insulin is required

Progression of diabetic retinopathy

Worsening f diabetic nephropathy

Increased risk of death in patients with diabetic cardiomyopathy.


The average person is about a quarter of an inch taller at night.

ELEVENTH HOUR GYNECOLOGY & OBSTETRICS                                                                             129

*Hb A1c estimation

Less than or equal to 8.5 -least chances of fetal malformation

9.5 % or more – greater chance of fetal malformation

Screening for gestational diabetes is done at 24-28 weeks

*In rheumatic heart disease,

The fetal outcome is usually good,

In cyanotic group of diseases, there is an increased chance of fetal loss and growth retardation.

*Anticoagulants in heart disease

If the woman is on Warfarin, then she should stop it as soon as pregnancy is detected,

It should be replaced by heparin, upto the end of first trimester,

After first trimester, heparin is replaced by Warfarin, till term.

At term heparin should once again replace Warfarin, till a week postpartum, after which Warfarin should be continued.

Indication of medical management in ectopic pregnancy
Hemodynamically stable patient


Sac size < 3.5 cm in diameter

B hcg < 2500 iu / ml

Methotrexte  is used

characteristics constriction ring retraction ring
Eponym Schroeder’s ring Bandl’s ring
Cause Undue irritability of uterus Obstructed labor
Location Usually at the junction of  upper and lower segment

May occur at other places

Position doesn’t alter

Always at junction of upper and lower segments

Progressively moves upward

Tenderness Absent Present
Palpation Fetal parts felt

Ring not felt

Round ligament not felt

FHS present

Fetal parts not felt

Ring felt

Round ligaments felt

FHS  usually absent

Vaginal examination Ring is felt Ring is not felt
Management To relax ring after delivery of body To relieve obstruction


Learn as though you would never be able to master it; Hold it as though you would be in fear of losing it- Confucius

ELEVENTH HOUR GYNECOLOGY & OBSTETRICS                                                                             130

*Encirclage is done at 14 weeks or 2 weeks earlier than lowest period of previous circlage

Most common site of metastasis from choriocarcinoma is lungs

*Couvelaire uterus

There is infiltration of blood and fluid in between the muscles bundles, leading to their necrosis, however it rarely interferes with uterine contractility, and hence is not an indication for hysterectomy


Blair Hartley’s sign Attitude of hyperextension or hyperflexion of fetal body

Seen after 3-4 weeks

Robert’s sign Gas  translucencies are seen in fetal heart and great vessels

Seen after 12 hours

Halo sign of Deuel Radiolucent halo around fetal cranium , due to edema of pericranial fat

Seen after 2 days

Helix sign Presence of gas in umbilical cord

Maternal serum alpha fetoprotein

-Wrong gestational age

-Open neural defects

-Multiple pregnancy

-Renal anomalies

-Anterior abdominal wall  defects



*Triple test

Used in detection of downs syndrome

Low msafp

High HCG

Low Estriol

*Acetylcholinesterase- Elevated in open neural tube defects

*Prolonged latent phase of labour

Latent phase exceeds 20 hours in primigravidae and 14 hrs in multigravida.


If you yelled for 8 years, 7 months and 6 days, you would have produced enough sound energy to heat one cup of coffee.

ELEVENTH HOUR GYNECOLOGY & OBSTETRICS                                                                            131

*Prolonged labour

Combined duration of first and second stage is more than 18 hours

Labour is considered to be prolonged when cervical dilatation rate is less than 1cm/hr; descent is less than 1 cm / hr for a period of more than 4 hrs

*Precipitate labour

Combined duration of the first and second stage is less than 2 hours.

*Prelabour rupture of membranes

Spontaneous rupture of membranes any time beyond 28th week, of pregnancy but before the onset of labour.

*Term prom

Rupture of membranes, occurring beyond 37th completed weeks but before the onset of labour

*Preterm prom

Rupture of membranes, before 37th week

*Examine the collected fluid from the posterior fornix,

Ph- increases as the acidic vaginal secretion is mixed with alkaline amniotic fluid,

Characteristic ferning pattern, on microscopy

Cells stained with Nile blue sulphate show orange blue colored cells

Organisms crossing placenta


Hepatitis b and c






Others (syphilis, tuberculosis )





An educational system isn’t worth a great deal if it teaches young people how to make a living but doesn’t teach them how to make a life.- Anonymous

ELEVENTH HOUR GYNECOLOGY & OBSTETRICS                                                                             132

*Transplacental transmission of toxoplasmosis

First trimester-low incidence of transplacental infection, but disease is more severe

Third trimester-high incidence, but severity is less

*Kassowitz’s law- If a woman having syphilis, has series of pregnancies, the outcome improves in later pregnancies

Complete-have only placental parts, as sperm fertilizes an empty ovum

Complete moles have 46 XX karyotype, the molar chromosomes being derived entirely from the father. (Androgenesis)

Incomplete -focal affection of the chorionic villi. So there is a fetus or an amniotic sac

Vaginal bleeding is the commonest presentation

White currant in red currant juice- blood may be mixed with fluid form the ruptured cysts.

USG -shows snow storm appearance  and Bunch of grapes appearance

High HCG titre.

Age > 35 years

Parity > 3

Initial HCG level in urine > 1 lac IU /hr

Histologically proven infiltrative mole

Previous history of molar pregnancy

*Risk of development of choriocarcinoma- 2-10 %

Routine follow up must be done for atleast 1 year, by regularly checking β HCG levels, and chest X rays.

The patient should use contraception, for atleast 2 years, to avoid confusion between fresh pregnancy and choriocarcinoma changes.

Threatened abortion Process of abortion has started but has not reached a stage, from where recovery is impossible.

External os is closed

Slight vaginal bleeding.

USG  indicates a healthy fetus

Fetal cardiac movements are present

Complete abortion Products of conception are expelled en masse.

Vaginal bleeding is absent/trace, following expulsion.

Cervical os is closed


At one time it was believed that citrus fruits could provide protection against poisons.

ELEVENTH HOUR GYNECOLOGY & OBSTETRICS                                                                             133


Inevitable abortion It’s a clinical type of abortion where the changes have progressed from where continuation of pregnancy is impossible-

Increased vaginal bleeding

Dilated internal os, through which products of conception are felt.

Incomplete abortion Entire products of conception are not expelled but a part of it is left inside the uterine cavity,

Persistence of vaginal bleeding.

Patulous cervical os

Missed abortion/ silent miscarriage When the fetus is dead and retained inside the uterus for a variable period

Persistence of brownish vaginal discharge. absent fetal heart sounds.

Cervix firm.

Empty gestational sac

Superfecundation Fertilization of two ova released in same menstrual cycles, by separate acts of coitus, within a short period of time.
Superfetation Fertilization of two ova released in different menstrual cycles
physiological causes of hyperprolactinemia
Early morning /sleep

High protein meal

Stress, physical or psychological

Late follicular phase of menstrual cycle

Pregnancy , suckling

Prolonged breast manipulation



*Sheehan’s syndrome

Severe postpartum hemorrhage, shock, or severe infection, leading to anterior pituitary necrosis, leading to failure of lactation, secondary amenorrhoea, loss of pubic and axillary hair, breast and genital atrophy, lethargy and hypotension

External Conversion is done by external manipulation only Breech presentation and Transverse lie.


Success isn’t permanent and  failure isn’t fatal-Mika Ditka

ELEVENTH HOUR GYNECOLOGY & OBSTETRICS                                                                             134


Internal Conversion is done by one hand introducing into the uterus and the other on the abdomen Transverse lie in case of second baby of twins.
Bipolar (Braxton-Hicks) Conversion is done introducing one or two fingers through the cervix and the other hand on the abdomen. Lesser degree of placenta previa when the fetus is dead, deformed or previable.
Indications for forceps application
Delay In the second stage of labour

Appearance of fetal distress

Cord prolapse

After coming head of breech

Low birth weight baby


Maternal distress


Post caesarean pregnancy

Heart disease

Conditions to be fulfilled for application of forceps
Suitable presentation and position

Cervix must be fully dilated and effaced

Membranes must be ruptured

Head must be engaged; station must be >+2

No obstruction should be present

Live baby

Uterus should be actively contracting and relaxing

Bladder should be empty.

Advantages of ventouse over forceps Advantages of forceps over ventouse
Can be used in unrotated and ,malrotated Occipito-posterior position

It can be applied through incompletely dilated cervix. (atleast 6cm )

Not space occupying

Lesser traction force required

Can be applied at higher station

Useful in suspected pelvic contraction

Quicker, hence more useful in fetal distress.

Safer in premature babies

Can be used in face presentation and after coming head of breech

Incidence of hemorrhages in fetus is less.


Most cows give more milk when they listen to music.

ELEVENTH HOUR GYNECOLOGY & OBSTETRICS                                                                             135

Indications of Ventouse
Deep transverse arrest with adequate pelvis

Delay in descent of  head of the second baby of  twins

Delay in first stage due to uterine inertia or primary cervical dystocia

As an alternative to forceps operation.

Contraindication to ventouse
Fetal distress

Pelvic contraction


Fetal bleeding disorder

Face presentation

Transverse lie

After coming head of breech

Partially dilated cervix

Head not engaged

Congenital anomalies

Dead fetus.

*Effective vacuum needed for ventouse is 0.8 kg/ cm2

complications of vacuum


Subaponeurotic or subgaleal haemorrhage

Retinal hemorrhage

Contraindication of caesarean section
Dead fetus

Baby so premature that it can’t survive ex-utero

Presence of blood-coagulation disorders.

indications of classical caesarean section
Previous classical caesarean section

Neglected shoulder with anhydramnios

Structural abnormality making approach to lower segment difficult

Constriction ring due to neglected labour

Fibroids in lower segment

Anterior placenta accreta and previa

Postmortem caesarean section

Very preterm fetus, where lower segment is poorly formed.


Success does not consist in never making blunders, but in never making the same one a second time.- Josh Billings

ELEVENTH HOUR GYNECOLOGY & OBSTETRICS                                                                             136

Indication of caesarean section.

Absolute indications Relative
Central placenta previa-

Severe degree of contracted pelvis

Cervical or broad ligament fibroid

Advanced carcinoma cervix

Cephalopelvic disproportion

Previous uterine scar

Fetal distress during first stage of labour

Abnormal uterine contraction

In sever degree  of Placenta previa

In lesser degree of placenta previa when bleeding continues despite low rupture of membranes.

Abruption placentae

Malpresentation-transverse lie, brow, mentoposterior position.

Bad obstetric history

Hypertensive disorders- acute fulminating pre-eclampsia, not responding to treatment, uncontrolled eclampsia

Failed surgical induction

Elderly primigravidae

Medical gynaecological disorders-chronic hypertension or chronic nephritis.

Uncontrolled diabetes

Uncorrected heart disease

Pelvic tumours

Vaginal atresia


Modern obstetrical forceps were invented by Peter Chamberlen around 1600 and kept a family secret for three generations.

When they arrived at the home of the woman in labor, the pregnant patient was blindfolded as to not to reveal the secret, all the others had to leave the room. Then the operator went to work. The people outside heard screams, bells, and other strange noises until the cry of the baby indicated another successful delivery.

ELEVENTH HOUR GYNECOLOGY & OBSTETRICS                                                                            137


Comments 101 - 128 of 128First« PrevNext »Last
  1. Hi there, I read your new stuff regularly. Your humoristic style
    is awesome, keep up the good work!

    chelsea Fodboldtrøje

  2. With thanks! Valuable information!

  3. Very good site you have here but I was curious about if you
    knew of any community forums that cover the same topics discussed in this article?
    I’d really like to be a part of group where
    I can get comments from other knowledgeable people that share the same interest.
    If you have any suggestions, please let me know.
    Thanks a lot!

    Juventus kläder

  4. I truly appreciate this article post.Really looking forward to read more. Want more.

  5. There as noticeably a bundle to learn about this. I assume you made sure nice points in features also.

  6. Can I merely say such a relief to discover somebody who really knows what theyre dealing with on the net. You actually have learned to bring a worry to light and make it important. The diet should check out this and fully grasp this side with the story. I cant believe youre less well-known simply because you undoubtedly develop the gift.

  7. If you are going for best contents like me, simply pay a visit this web site
    all the time because it gives feature contents, thanks

    Liverpool drakt

  8. Looking around I like to look around the internet, regularly I will just go to Stumble Upon and follow thru

  9. Thanks-a-mundo for the article post.Thanks Again. Great.

  10. Pretty nice post. I just stumbled upon your blog and wanted to say that I ave truly enjoyed browsing your blog posts. In any case I will be subscribing to your feed and I hope you write again soon!

  11. Regards for helping out, fantastic info.

  12. There as certainly a lot to find out about this subject. I really like all the points you made.

  13. With thanks! Valuable information! https://newone2017.com/

  14. Don’t wear seat belts lest you drown in you own urine?

  15. What’s up i am kavin, its my first time to commenting anyplace, when i read this piece of writing i thought i could also make comment due to this good

    Billige chelsea fodboldtrøjer

  16. Thanks for sharing your thoughts about Study MBBS. Regards

    Billige dortmund fodboldtrøjer

  17. Hi, Neat post. There is a problem together with your
    site in internet explorer, might test this? IE still is the market leader and a big element of other people will miss
    your magnificent writing because of this problem.

    maglia Milan poco prezzo

  18. I blog often and I truly appreciate your information. This great article has really peaked my interest.

    I will bookmark your website and keep checking for new information about once per week.
    I subscribed to your RSS feed as well.

    Olympique Marseille Fotballdrakt

  19. Excellent post. I was checking continuously this blog and I am impressed!
    Very useful information specifically the last part 🙂 I care for such info a lot.
    I was seeking this particular info for a long time. Thank you and good luck.

    Liverpool ny trøje

  20. Remarkable things here. I am very glad to look your article.
    Thank you so much and I’m having a look forward to contact you.
    Will you kindly drop me a e-mail?

    magliette Atletico Madrid

  21. Whoa! This blog looks exactly like my old one! It’s on a
    entirely different subject but it has pretty much the same
    page layout and design. Great choice of colors!

    Tottenham Hotspurs fodboldtrøje med tryk

  22. You could certainly see your expertise in the article you write.
    The arena hopes for even more passionate writers such as you who are not afraid to mention how they believe.
    At all times follow your heart.

    Napoli tröja 2018

  23. whoah this weblog is wonderful i really like reading your articles.
    Stay up the good work! You understand, many persons are hunting round for this information, you
    can aid them greatly.

    fodboldtrøjer online

  24. I was excited to find this website. I wanted to thank you for your time for this wonderful read!!

    I definitely enjoyed every part of it and I have you saved as a favorite to see new information in your web site.

    Billiga fotbollströjor

  25. There is certainly a great deal to find out about this issue. I really like all of the points you ave made.

  26. This is really interesting, You’re a very skilled blogger.
    I’ve joined your rss feed and look forward to seeking more of your wonderful post.
    Also, I have shared your website in my social networks!

    fotballdrakter online

  27. Excellent site. Plenty of helpful info here. I am sending it to several friends ans additionally sharing in delicious.
    And naturally, thanks on your sweat!

    Kjøp fotballdrakter

  28. state. This is the first time I frequented your web page and up to now?

Comments 101 - 128 of 128First« PrevNext »Last

Leave a Reply