Radiology of gyn ( slide show )
‫نقول الزم صوره جات اذا مالحظه‬
Test ( us / hsg / xray ..) + finding in pic
Pelvic U/S
1-multiple pregancy ( diamiotic dichorionic ) lumbda like shape
2-multiple pregancy ( dioamiotic monchronic ) T like shape
3-ectopic pregancy
4-molar pregancy
5-polyovarin cyst
6-twin twin transfusions
7-multiple pregancy blighted ovum
HSG
1-didelphs + fallopine tube blocked
2-bilateral blocked fallopine tube ( normal uterus )
3-bicornate uterus
4-unicornate uterus
Pelvic x-ray
1-missed IUD
2-fibroiod calcifaction
* I tired to collect most of Doctor comments for each Tutorial lectures giving today .
- Cystic hygroma very characteristics feature of turner syndrome .
- Hydrocephaly : most common site of shunt is peritoneum .
- Cleft lip and palate can be bilateral not always unilateral and not always the cleft lip and palate comes
together . In these condition fetus suffering from Feeding but now there is a spacial nipples .
- 3 main difference of omphalocele and gastrocele in covering ,site and mood of delivery.
- "Covering" : omphalocele covered by sac and no sac for gastrocele .
- " Site " : omphalocele opening in the umbilicus .
- " Mood of delivery " : omphalocele can be C/S or normal vagina delivery while gastrocele always C/S .
- Treatment of testicular feminization are : 1/ to remove the testis for the risk of malignancy , 2/
hormonal replacement therapy , 3/ psychological therapy .
- septated uterus one of the cause of fertility treated by removing the septum but explain to the patient
that even after removal we cant guarantee 100% that you can get pregnant because it might be the
cause of infertility is unexplained infertility .
- The main characteristics of toxoplasmosis are Hydrocephalus ,chorioretinitis
, Intracranial calcification .
- IgG for immunity test , IgM for check of infection .
- Hermaphroditism : most of them converted to female and whenever you convert remove the other
genatilia ( male gentaila for the risk of malignant )
Case scenarios
30 weeks came to antenatal care her previous pregnancy was Norma .her Eamination also normal .
1-mention 2 antenatal lab tests?
- Complete blood count with differential
- urinanalysis
- random blood sugar
2- she follow up GCT high what is dx?
Gestational diabetic Melitus
3-what first management?
Put her on Diet
4- she continue follow up AFI >40 cm
Baby > 4kg what is your impression?
Polyhaydroamnios
Macrosomia
5- you check FBG 2hr postprandial was high
Next management?
Insulin
6-she reach 38 w GA after insulin normal delivery mention 2 maternal and 2 fetal complications of the
pathology ?
Maternal >>> preeclampsia-PPH
Feta >>> Macrosomia-IUFD
Case scenarios
22 years old primgravida 7 weeks pregnant came to you complaining of lower abdominal pain and
vaginal bleeding
1-ddx?
- abortion
-molar pregnancy
2-mention 2 investigations?
- BhcG
- US
3- you found BhcG - 2000000 and US shows snow storm appearance what is you provisional dx?
Molar pregnancy
4-what first management?
- dilatation and Curettag(D&C) evacuation
5-how you follow up your patient?
Monitoring BhcG
6- during follow 6 months later BhcG drop to 2000 or 5000
What is Next management?
Methotrexate
7-mention 2 side effects of this treatment ?
-nausea - vomiting - leukopenia
8- 2 complications of this pathology?
-recurrent
-
Same scenario BUT
22 years old primgravida 7 weeks pregnant came to you complaining of lower abdominal pain and
vaginal bleeding
1-ddx?
- abortion -molar pregnancy 2-mention 2 investigations?
- BhcG
- US
3-BhcG-1000
US >empty and left adnexal mass what is your provisional dx?
Ectopic pregnancy
4- 3 options of treatments?
- ............ Salpengectomy
- medication ( methotrexate)
- conservative
4- while you observe start dizzy severe lower abdominal pain BP was 60/40
What is your impression?
Rupture of ectopic pregnancy
5-what is management?
- labrotomy salpengectomy
6- after her management and she discharged ask for contraception which contraceptive you will advice
her against?
IUD contraceptive
‫تجريبي اختبار‬
55 years / p5+0 complaining of irregular bleeding
1- Mention two questions you will ask her
2-Two signs to look for during examination
MCQ
-Threatened abortion
-Gastesional hypertension +Pre-eclampsia
- labia>>> scrotum
- thelarch>>> breast development
- intraspinous >>> number
- incidence>>> asthma
- cause of endometriosis >>> unknown
- mediciolegal>>>
-maternal high risk
- indirect cause of death
( mortality/morbidity)
- case: contour > normal in labrotomy and septate uterus> in hysteroscopy ...... Dx
Septate uterus
- contraception (IUCD)>>>> not used in ectopic pregnancy
- sickle cell anemia >>> IV fluid
- contraindications in pregnant with heart diseas >>> ACE inhibitors
- apgar score >>> 7 or more than 7 good
- about pureperium >>>> uterus decrease in size after 6 weeks
- maternal complications >>
- fetal complications of amnioinfusion >>
-interns os closed and minimal bleeding no significant abdominal pain>>>> threatend abortions
- about placenta abruption ....
-mentogmery gland >>>>>> physiology change of breast
- PCO >>>>> change metabolism of androgen and estrogen and abnormal sec
-hydiated mole>>>>risk of malignancy
-Most common cancer in uterus
-Chemotherapy of cervical cancer >>> cisplatin
- snow storm appearance >>> molar pregnancy
- copious, offensive discharge >>>
- dysfunctional uterine bleeding what is true >>>
-Rh- iso >>>> anti D igG antibodies
-contraindications of tocolytics >>>
-50 years menopausal with irregular bleeding and biopsy for endometrial cancer negative
>>>>> hysterectomy
-cerebral calcifications >>> in toxoplasmosis or cytomegalovirus
- GDM >>>> definition
- normal fetal presentation >>> cephalic
- maternal and fetal complications!!! Which fetal or maternal complications (may be 8 questions)
-fetal complication>>>>IUGR
-maternal complication>>> postpartum hemorrhage
*name >>>Bandage seissor >>>uses and complications
*>>>Labroscopic ovarian cystectomy
*Genetic
*Baby head with redness of neck and a little enlarged >> we don't know but may be cystic hygroma
*name>>>Hysterosalpingogram
dx >>>unicurnate uterus
* cordocentesis( uses / complications)
*name >> pelvic ultrasound
Dx >>>multiple gestation
*forceps( indications and complications)
*CTG
*Rubbela syndrome
*Histology picture cancer >>>
*Fetus electrode and complications
*Congenital ( not clear)
*Prolapse (type and management)
*Vagainal ring ( indications\disadvantage)
Case scenarios:
-Pregnancy induced Hypertension >>>>>> preeclampsia ( in the mid of case asked about antenatal
assessment)
-Threatened abortion
Malpersenation
Breech ( most common ) frank postion
Should assase
1-breech presentation
2- vaginal delivery
3-c/section
Maternal complication
**** infection
**** laceration
**** injury
Fetal complication
*** fetal disterss
*** umblical cord competsion
*** injury of internal organ
Sholder presentation
DefinTion
Complication ( maternal / fetal )
Indcation
Tocolysis ( anti -contraction medication )
Ideal usesd in case of
1-stable hemodynamics
2-no IUFD (fetal jeopardy )
3-perterm fetal
Methotrexate
Ideal criteria
1-Stable hemodynamics
2-normal liver and renal function
3-follow up can be in multiple times
1-Imparid pelvic floor + urethral hyper motility ~> stress urinary incontinence
2-involuntary overactive of detrusor mucsle ~> urge urinay incontinence
3-hypermotility of urthra + detrusor mucsle involuntary overactive ~> mixed urinary incontinence
4-neurogical disease ~> reflex urinay incontinence
5-incomplete empty of bladder secodary to imparied of detrusor mucsle ( diseases affected on it ) ~>
overflow urinary incontinence
6-normal voiding but some physiological / psychological factor lead to ~> funictonal urinary
incontinence
No symptoms just wetness
Classic cause urogential fisula
Genitourinary congeintal malformation
Non functioning urthra secondary to other disese ~> continuous urinary incontinence
Lab investagtion
1-urinanlysis
2-urine culture
3-urine cytology
4-renal function test
5-diabetes test
6-post vioding resdiual urine volume
-Most test from pelvic floor ~> pelvic MRI
-best disgnostic test for urthral diverticlum ~> postive pressure urthrogram
-best test for urinary tract fistula is ~> cystourethrogram
-best test for differenate between urterovesical fistula and vesicovaginal fistula ~> IVP
DDX
1-UTI female
2-UTI male
3-utrine prolpse
4-spinl cord trama and related disese
5-spinal epidural abcess
6-MS
7-vaginitis
8-prostatitis
Tretment of stress incontinence
***** pelvic floor physiotherapy
***** medication
Surgery
*** in case of increase outlet resistance
Treatment of urget incontinece
1-diet
2-behavior modefaction
3-pelvic floor ex
4-medication
Surgery ~> incarese bladder capacity
Or compliance ( in different way of producers )
Treatment of mixed incontinece
1-pelvic floor ex
2-parasympatholytic agent
3-surgery
Treatment of overflow incontinece
1-catheterization
2-diversions
Treatment of functional incontinence
Find cause and treat it
Complication
1-UTI
2-Cellulitis
3-Urosepsis and death
4-psycholoical problem
5-presure sore