Gyneacology cases

RK

Uterine vs ovarian mass

Ovarian mass

Uterine mass

1) site 2) consistency

Right/left iliac fossa(but in advance Midline, laterally(in stage can extend to suprapubic area pedunculated fibroid) Cystic( because common masses in Firm(fibroid) reproductive age are benign cyst) or solid or solid cystic(mix type) Up and down, side to side Rounded and smooth Only side to side lobulated

3) mobility 4)surface

5)Get below
6)percussion 7) Bimanual exam a)mass movement in relation with cervix b) Angle of the mass

Can get below mass

dull a)When mass is moved towards xiphisternum, the cervix will not move(unless uterus attach by adhesion). The mass lies in the side of the uterus. A groove can be felt between uterus and ovarian mass b)<90

Cannot get below mass

dull a)When the mass is moved towards xiphisternum, the cervix will move away from the examining finger b)>90

Uterine fibroid vs adenomysis

Uterine fibroid
Commonest benign uterine tumor Common among women aged 30 yrs and above

Adenomyosis
Relatively less common Common among women age 35 and above(generally in older population compared to uterine fibroid)

Causes mainly menorrhagia(Pt Causes mainly dysmenorrhea and experience back pain due to heavy bleeding usually starts even before menses) the cycle) Mass can be in any size Mass can only grow about 14 weeks of size(due to collection of blood in the myometrium) Mass is tender during menstrual flow

Mass is commonly non tender

Benign vs malignant mass

Benign mass
1) age Reproductive age

Malignant mass
Extreme age(very young usually tumor of germ cell origin), elderly in postmenopausal woman (epithelial origin) Cachexic, pale, ill looking present

2)General appearance 3)ascites

well absent

4)organomegal y 5)Features of mass

absent
Mostly cystic, mobile, smooth surface and margin

Has organomegaly
Hard/mix consistency, restricted mobility, irregular surface and margin

Obstetrics cases

Poly vs oligohydramnions
Polyhydramnions
Features: Grossly distended abdomen, skin stretched with fullness in the flank Uterus larger than date Difficulty in palpating fetal parts Positive fluid thrill (must demo in exam)

oligohydramnions
Features Uterus smaller than date Fetal parts easily palpable

LGA vs SGA
Causes Maternal Large for gestational age Wrong dates Polyhydramnions(GDM) Multiple pregnancy Mass(uterine fibroid) Molar pregnancy(rare) Fetal anomaly which reduce absorption(spina bifida, anencephaly, esophageal atresia) Hydrops fetalis Polyhydramnions(GDM) Fetal macrosomia (GDM) Chorioangioma of the placenta(very rare) Small for gestational age Wrong dates Oligohydramnions Missed miscarriage(<24wk IUD(>24 wk)

Fetal

Failure to thrive(IUGR in PIH mother) Oligohydramnions(with IUGR) Fetal anomaly(renal agenesis, potter syndrome, urethral valve anomaly) _

Placental

Emergency vs elective c-section

Emergency caesarean section Elective c-section

Fetal distress Umbilical cord prolapse Abruptio placenta Failed instrumental delivery Bleeding placenta previa(warrant for termination of pregnancy) Failed induction of labour/no progress in labour despite adequate time Fetal malpresentation/malposition(brow, shoulder, face, locked twins Severe pre-eclampsia/eclampsia with fetal distress

Placenta previa Cephalo pelvic disproportion 2 or more previous LSCS(uterine rupture risk) Breech presentation(with failed ECV) Macrosomic baby(>4 kg) Oblique/transverse lie IUGR(fetal unable to withstand labour stress) GDM(risk of shoulder dystocia due to macrosomia) Tumors obstructing pelvic inlet(impacted ovarian tumor/uterine fibroid) Precious pregnancy(history of multiple stillbirth/long standing subfertility)