Intrapartum Fetal Heart Rate Monitoring (Usmle)

OBGYN: Intrapartum Fetal Heart Rate Monitoring (Usmle)

Mnemonic to remember : VEAL CHOP

Variable     Cord compression
Early          Head compression
Acceleration OK
Late         Placental Insufficiency

Early Deceleration: Head compression. Fetus deceleration is symmetrical to mother's contraction. Tx = No treatment

Late Deceleration : Placental insufficiency : Fetal deceleration is after the mother's contraction Tx= test fetal blood from scalp sample to diagnose hypoxia or acidosis.

Variable Deceleration : Cord compression. Fetal deceleration can be symmetric or after mother's contraction (Onset of fetal deceleration to the nadir should be < 30 sec.)
Tx = 1. Change the mother's position
     2. Amnioinfusion

STD's with Ulcers and No Ulcers

STD's 

With Ulcers :

Syphilis (Painless)
LGV
Genital herpes (Painful)
Granuloma inguinale
Chancroid (Painful)

No ULCERS 

Chlamydia
HPV
Gonorrhea
Hepatitis B
HIV

Types of Miscarriage

Threatened 

• Vaginal bleeding
• Closed cervical os
• Fetal cardiac activity

Missed

• No vaginal bleeding
• Closed cervical os
• No fetal cardiac activity or empty sac

Inevitable

• Vaginal bleeding
• Dilated cervical os
• Products of conception may be seen or felt at or above cervical os

Incomplete 

• Vaginal bleeding
• Dilated cervical os 
• Some products of conception expelled and some remain

Complete

• Vaginal bleeding or none
• Closed cervical os 
• Products of conception completely expelled

Staging of Cervical Cancer

Staging of Cervical cancer.

Anatomic display of  the stages of  cervix cancer, defined by location, extent of tumor, frequency of  presentation, and  5-year survival

Family Planning Methods of Contraception by Dr Jeetendra C

Management of Cervical Neoplasia in Pregnancy

Cervical Neoplasia in Pregnancy

Dx: Colpo & Biopsy, Do not perform ECC because of increase vascularity

Management of Cervical Neoplasia in Pregnant .

CIN intraepithelial :

• Pap & Colpo every 3 months
• PP 2 months: revaluate & Rx

MICRO invasion  :

• Cone biopsy: r/o frank invasion Follow conservatively, then Vaginal Delivery
• PP 2 month: treat residual lesions

FRANK invasion :

• less than 24 wk: ignore pregnancy, Rx CA
• greater than 24 wk: wait to 32 wk, then CS & treat CA per staging 

RAH :

Radical abdominal hysterectomy (RAH)

• Radical abdominal hysterectomy specimen with fetus in situ performed at 18 weeks of gestation for stage IB cervical cancer.

Trimethylamineuria (Fish Odor Syndrome)

Trimethylamineuria (Fish Odor Syndrome)

• autosomal recessive

• A rare clinical entity with an offensive persistent odor that no amount of bathing or washing or perfuming will correct.

Vaginal Discharge

Differential Diagnosis :  Normal : Lactobacillus 70 % and non-Lactobacillus 30 %

• Bacterial Vaginosis  ----- 50 %
• Candida                    ----- 30 %
• Trich                         ----- 15 % 

Visual inspection : Inflammatory response Vaginal discharge e.g thin-thick gray-white-green,frothy

Vaginal pH : Normal: < 4.5 Use Nitrazine paper

Micro-exam : Wet Prep Saline and KOH

Urinary incontinence types and its treatment

Ask your patient about the symptoms ? 

Bladder diary: Name / Date

Fluids

• type and amount of fluids

Urination 

• Strong urge to urinate (Y,N)
• Amount urinated in toilet (S,M,L)

Accidents

• Amount of leakage (S,M,L)
• Activity preceding leakage

Here are the examples of Urinary incontinence