DIMS Lectures Gynecology & Obs PDF

Here is the complete pdf lecture of obstetrics and gynaecology by Dr. Tahir Malik

Introduction

Gynecology and Obstetrics is the field of medicine focusing on the female reproductive system, pregnancy, childbirth, and postpartum care.

Anatomy of the Female Reproductive System

External Genitalia:

• Vulva: Includes the labia majora, labia minora, clitoris, and vestibule.
• Perineum: Area between the vaginal opening and the anus.
• Bartholin’s Glands: Provide vaginal lubrication.

Internal Genitalia:

• Vagina: Muscular canal connecting the uterus to the external genitalia.
• Uterus: A pear-shaped organ responsible for menstruation and pregnancy.
  • Endometrium: Inner lining, sheds during menstruation.
  • Myometrium: Muscular middle layer.
  • Perimetrium: Outer layer.
• Fallopian Tubes: Pathway for the ovum from the ovary to the uterus.
• Ovaries: Produce ova and secrete hormones (estrogen and progesterone).

Menstrual Cycle

Phases:

• Follicular Phase (Day 1-14): FSH stimulates follicle growth; estrogen peaks.
• Ovulation (Day 14): LH surge causes follicle rupture and ovum release.
• Luteal Phase (Day 15-28): Corpus luteum secretes progesterone to prepare the endometrium.

Hormonal Regulation:

• FSH & LH (from the pituitary gland) regulate follicular development and ovulation.
• Estrogen & Progesterone (from the ovaries) maintain the endometrium.

Menstrual Disorders

Amenorrhea

• Definition: Absence of menstruation for at least 3 cycles or 6 months.

• Types:

  • Primary Amenorrhea: Failure to attain menarche by age 15.

  • Secondary Amenorrhea: Cessation of previously normal menstruation.

• Causes:

  • Hypothalamic dysfunction (stress, weight loss, excessive exercise).

  • Polycystic ovary syndrome (PCOS).

  • Hyperprolactinemia.

  • Thyroid dysfunction.

• Diagnosis:

  • Serum FSH, LH, Prolactin, and TSH levels.

  • Pelvic ultrasound to assess ovarian morphology.

• Management:

  • Treat underlying cause (e.g., thyroid replacement for hypothyroidism).

  • Hormonal therapy (combined oral contraceptives) for regulation.

Dysmenorrhea

• Definition: Painful menstruation affecting daily activities.

• Types:

  • Primary Dysmenorrhea: No underlying pathology, due to prostaglandin release.

  • Secondary Dysmenorrhea: Due to underlying conditions (endometriosis, fibroids, pelvic inflammatory disease).

• Clinical Features:

  • Crampy lower abdominal pain before or during menstruation.

  • Pain radiating to the back and thighs.

• Diagnosis:

  • History and pelvic examination.

  • Ultrasound if secondary causes are suspected.

• Management:

  • NSAIDs (Ibuprofen, Naproxen) for prostaglandin inhibition.

  • Oral contraceptives to suppress ovulation.

  • Lifestyle modifications (exercise, heat therapy).

Infertility

• Definition: Failure to conceive after 1 year of unprotected intercourse.

• Types:

  • Primary Infertility: No prior pregnancies.

  • Secondary Infertility: Previous conception but unable to conceive again.

• Causes:

  • Ovulatory disorders (PCOS, premature ovarian failure).

  • Tubal factor infertility (PID, endometriosis).

  • Male factor infertility (low sperm count, erectile dysfunction).

• Diagnosis:

  • Ovulatory assessment (Serum FSH, LH, AMH, Progesterone levels).

  • Hysterosalpingography (HSG) for tubal patency.

  • Semen analysis in male partner.

• Management:

  • Ovulation induction (Clomiphene citrate, Letrozole).

  • Surgical correction of tubal blockages.

  • Assisted reproductive techniques (IVF, IUI).

Pregnancy

Physiological Changes:

• Cardiovascular: Increased blood volume and cardiac output.
• Respiratory: Increased tidal volume and oxygen demand.
• Renal: Increased GFR and renal plasma flow.
• Hematologic: Hypercoagulable state.

Stages of Pregnancy:

• First Trimester (0-12 weeks): Organogenesis, fetal heartbeat detected.
• Second Trimester (13-28 weeks): Fetal movements felt.
• Third Trimester (29-40 weeks): Rapid fetal growth, lung maturation.

Antenatal Care:

• Regular ultrasound scans.
• Screening for gestational diabetes, preeclampsia, and fetal anomalies.
• Iron and folic acid supplementation.

Common Gynecological Disorders

Polycystic Ovary Syndrome (PCOS)

• Clinical Features: Irregular periods, hirsutism, acne, obesity.
• Diagnosis: Rotterdam criteria (Oligo/anovulation, hyperandrogenism, polycystic ovaries on ultrasound).
• Management: Lifestyle modifications, oral contraceptives, metformin.

Endometriosis

• Definition: Ectopic implantation of endometrial tissue outside the uterus.
• Symptoms: Pelvic pain, dysmenorrhea, infertility.
• Diagnosis: Laparoscopy (gold standard).
• Management: NSAIDs, hormonal therapy, surgery.

Uterine Fibroids

• Definition: Benign smooth muscle tumors of the uterus.
• Symptoms: Heavy menstrual bleeding, pelvic pressure, infertility.
• Diagnosis: Ultrasound, MRI.
• Treatment: Medical (GnRH analogs), surgical (myomectomy, hysterectomy).

Common Obstetric Complications

Preeclampsia

• Definition: Hypertension and proteinuria after 20 weeks of gestation.
• Symptoms: Headache, visual disturbances, edema.
• Complications: Eclampsia, HELLP syndrome, fetal growth restriction.
• Management: Antihypertensives, magnesium sulfate, delivery.

Gestational Diabetes Mellitus (GDM)

• Risk Factors: Obesity, family history, previous GDM.
• Diagnosis: Oral glucose tolerance test (OGTT).
• Management: Diet control, insulin if needed.

Preterm Labor

• Definition: Labor before 37 weeks of gestation.
• Risk Factors: Infections, multiple gestations, uterine anomalies.
• Management: Tocolytics, corticosteroids for fetal lung maturity.

Placenta Previa

• Definition: Placental implantation over the cervix.
• Symptoms: Painless vaginal bleeding in the third trimester.
• Diagnosis: Ultrasound.
• Management: Cesarean section if complete previa.

Labor and Delivery

Stages of Labor:

1. First Stage: Cervical dilation and effacement.
2. Second Stage: Delivery of the baby.
3. Third Stage: Delivery of the placenta.

Types of Delivery:

• Normal Vaginal Delivery (NVD).
• Cesarean Section (C-section).
• Instrumental Delivery (Forceps/Vacuum).

Postpartum Care

Normal Postpartum Changes:

• Uterine involution, lochia (vaginal discharge).

• Hormonal adjustments.

Common Postpartum Complications:

• Postpartum Hemorrhage (PPH): Excessive bleeding after delivery.

• Postpartum Depression: Persistent low mood, anxiety.

• Mastitis: Breast infection due to blocked ducts.

Case Example: A 28-Year-Old with Severe Preeclampsia

1.A 28-year-old pregnant woman at 32 weeks gestation presents with severe headache, hypertension (170/110 mmHg), and proteinuria. 

2.A 22-year-old female presents to the gynecology clinic with irregular menstrual cycles and heavy bleeding for the past 8 months. She reports prolonged periods lasting 10-12 days, sometimes requiring double sanitary pads. Her cycles are unpredictable, occurring every 2 to 6 weeks. She denies pregnancy, but reports acne, weight gain, and excessive hair growth on her face and abdomen.

3.A 27-year-old woman presents to the emergency department with intermittent lower abdominal pain for 5 days. The pain started as a dull ache but has now become sharp and localized to the right lower quadrant. She also reports mild vaginal spotting but denies heavy bleeding. Her last menstrual period (LMP) was 6 weeks ago, but she has a history of irregular cycles.

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1.Diagnosis: Severe Preeclampsia

2.Diagnosis: Polycystic Ovary Syndrome (PCOS) – Anovulatory Dysfunction

3.Diagnosis: Suspected Ectopic Pregnancy

 

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