complications of shoulder dystociaFractured clavicle
Fractured humerus
Erb-Duchenne palsy (5th and 6th cervical nerves)
Klumpke palsy(★ 8th cervical and 1st thoracic nerve, ★can complicated with Horner syndrome)
Perinatal asphyxia OBGYmusculoskeletalUWorld step2CK HirotoShishido
treatment of pregnant woman with symptomatic bacterial vaginosisTreatment of symptomatic BV is metronidazole(500mg twice daily for 7 days)or clindamycin, regardless of pregnancy status. There were concerns about using metronidazole during the first trimester due to possible teratogenicity, but studies have shown no increased risk of congenital anomalies. OBGYinfectious diseaseUWorld step2CK HirotoShishido
symptoms of abruptio placentae強い下腹部痛，少量の外出血と強度の貧血，板状硬の子宮壁と著明な圧痛，胎児心拍数陣痛図（CTG）で剝離面に比例する基線細変動の減少あるいは消失，胎盤後血腫の超音波所 114回 必修OBGY HirotoShishido
diagnosis for chorioamnionitis(CAM) intraamniotic infection
inflammatory breast cancerDermal lymphatic space invasion→ breast pain with warm, swollen, erythematous skin around exaggerated hair follicles, ☆peau d’orange.
Poor prognosis (50% survival at 5 years). Often mistaken for mastitis or Paget disease. Usually ☆lacks a palpable mass.
"inflammatory" is a misnomer because the classic skin findings are not due to infection but are instead caused by cancerous cells obstructing lymphatic drainage after spreading to the dermal lymphatic spaces. breast surgeryOBGYUWorld HirotoShishido
invasive lobular (breast) carcinoma↓E-cadherin expression(diffuse gastric cancer)→ orderly row of cells (“single file”) and no duct formation. Often lacks desmoplastic response.
comedocarcinomaSubtype of DCIS(dultal carcinoma in situ). Cells have ☆high-grade nuclei with extensive central necrosis and dystrophic calcification breast surgeryOBGYUWorld HirotoShishido
OCPs/ PCOS to gynecologic malignancyOCPs → ↑cervical cancer, ↑breast cancer ↓ovarian cancer
treatment for postpartum hemorrhageuterine massage, ¥oxytocin. If refractory, surgical ligation of uterine or internal iliac artery (will preserve fertility since ovarian arteries provide collateral circulation). reproductiveOBGYAmboss level4 HirotoShishido
warfarin effects on fetusBone and cartilage deformities (stippled epiphyses, nasal and limb hypoplasia), optic nerve atrophy, fetal cerebral hemorrhage. embryologyreproductiveOBGY HirotoShishido
ABG change in pregnancy↑progesterone
→ stimulate the hypothalamus to increase respiration drive primarily via ↑tidal volume (hormone induced laxity of the intercostal muscles allows for enlargement of the throracic cavity) + a slight ↑RR
→ ☆chronic hyperventilation
placenta accreta/increta/percreta(morbidity adherent placenta)
Placenta accreta—placenta attaches to myometrium without penetrating it; most common type.
Placenta increta—placenta penetrates into myometrium.
Placenta percreta—placenta penetrates (“perforates”) through myometrium and into uterine serosa (invades entire uterine wall) reproductiveOBGYUWorld HirotoShishido
target of colposcopyThe TZ(transformation zone) undergoes active cell division, young women are vulnerable to the oncogenic effects of human papillomavirus (HPV) infection and tobacco use.
Therefore, ☆the TZ is the most common site of cervical dysplasia/neoplasia. A colposcopy visualizes this area for biopsy.
congenital torticollistypically develops by 2 to 4 weeks of age
It is most commonly caused by birth trauma (eg, breech delivery) or ☆malposition of the head in utero (eg, due to fetal macrosomia or oligohydramnios),both of which can result in sternocleidomastoid muscle(SCM) injury and fibrosis. OBGYpediatricsUWorld HirotoShishido
GI functions of pregnant womanProgesterone decreases colonic smooth muscle activity and decreases fasting MMCs in the small intestine
Gravid uterus mechanically impedes small intestine transit
renal functions of pregnant womanIncreased blood volume and cardiac output result in the following alterations in renal hemodynamics:
• Increased renal plasma flow (RPF), ☆which peaks at 12 weeks gestation.
• Increased glomerular filtration rate
• Increased creatinine clearance, leading to decreased serum creatinine levels, typically by an average reduction of approximately 0.4 mg/dL renalOBGYUWorld HirotoShishido
