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IMPORTANT : Number-dependant and number-including questions represent at least

30% of the total questions of a Gynecology&Obstetrics exam , numbers include

(doses,periods,percentages ..etc) ,, most of us don't pay attention to numbers , most of

them are confusing , here is a brief including the main im...portant numbers in Obst.

Curriculum of end of round exam (which are in red): ((Numbers are copied from thedepartment Book))

**********************OBSTETRICS******************

********

*Age of viability = 28 weeks gestation

*30% of women experience slight bleeding in the first trimester

*15-20% of all pregnancies end in spontaneous abortion

*80% of all abortions occur in the 1st. Trimester & 20% in the 2nd trimester

*Chromosomal anomalies count for >50% of cases of spontaneous abortion

*50% or more of cases of threatened abortion will continue normally

*Surgical evacuation of the uterus is done only if the uterus is less than 12 weeks

gestation in size

*Spontaneous expulsion of missed 2nd trimesteric abortion occurs within 2-4 weeks

*Incidence of recurrent abortion = 1-2% of all pregnancies

*Incidence of isthmic incompetence = 0.5-1 %

*Isthmic incompetence surgery is done between 12-14 w. Gestation

*Success rate of McDonald's operation = 75-80%

*Disturbance of pregnancy in a rudimentary horn occurs at 4th or 5th m.

*Tubal ectopic represents 99% of all ectopic pregnancies

*Intrauterine gestational sac is seen by abdominal US at serum hCG level of 5000-5000

miu/ml and by vaginal US at 1000-2000 miu/ml

*Theca-leutin cysts are present in about 50% of gestational trophoblastic diseases

*Incidence of vesicular mole is < 1% of all pregnancies

*Recurrence rate of vesicular mole = 1-2%

*Prophylactic chemotherapy in acase of mole is indicated only with high risk

pregnancies at hCG level of > 100,000 miu/ml & theca-leutin cysts of >6 cm in diameter

*Malignant change of vesicular mole counts for 20% of all mole cases

*Follow up by serum hCG level in a vesicular mole is done as :

Weekly for 3 consecutive weeks then,

Monthly for 3 consecutive months then,

Every 2 months for a total 1 year

*After normal pregnancy serum hCG level declines in 6 w. , however in vesicular mole

it usually declines in about 9 weeks

*Suspicion of melagnancy in a vesicular mole is present when serum hCG level doesn't

dec. After 12 w. Or returns after decline*Incidence of Acc. Hge. = 1%

*Incidence of placenta previa = 1/300-1/500 of all pregnancies

*Normal CVP = 4-8 cmH2O

*Perinatal mortality in concealed acc. Hge. =95% , but in revealed = 50%

*Hypertensive disorders(in general) complicates 5-10% of all preg.

*Incidence of PE superimposing chronic htn. = 20-25%

*Chronic hypertension(not related to preg.) persists after preg. By > 12w.

*Hypertension of preeclampsia resolves after pregnancy by 6 w.

*Proteinuria of PE = >300mg/24h.

*Proteinuria of severe PE = 5gm/24h.

*Eclampsia complicates 1-2% of all cases of PE*HELLP syndrome complicates 2-4% of cases of PE

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Average amount = 30-50 cc

Average interval = 24 32 d. (28d.)

*Female ovary at time of puberty contains about 400,000 primordial follicles

*Follicular phase = 14 d. (variable)

*Luteal phase = 14 d. (constant)

*Life span of CL = 9 d.*Ovulation takes place 36 h. after LH surge & 12 h. after LH peak

*Placenta starts steroidogenesis at 8th w. gestation

*Decidua basalis represents 25% of the endometrial thickening

*Normal Spinbarkeit test (cervical mucus threads 7-10 cm.)

* PrimaryAmenorrhea:

Absence of menses with 2ry sexual ch. at 16y.

Absence of menses without 2ry sexual ch. at 14y.

*Secondary Amenorrhea is cessation of menses for > 6m.

*Incidence of Imperforate hymen = 0.1%

*Complete or partial Mullerian agenesis(Rokitansky syndrome) is 44XX

*Testicular feminization genotype is 44XY

*Y-containing gonads in testicular feminization carries 20% risk of

malignancy(gonadoblastoma)

*Complete Turner is 45XO

*Mosaic Turner is 46XX or 45XO

*In premature ovarian failure FSH level is >40 ng/ml

*Pituitary microadenomas are < 10mm. in diameter

*Pituitary macroadenomas are >10mm. in diameter

*Infantile uterus, body/cervix ratio = 1/1

*Adult uterus, body/cervix ratio = 2/1

*Doses of drugs used in ttt of hyperprolactinemia :

Bromocryptine = 1-2 tablets daily(4-6 weeks)

Cabergoline = 1/2 tablet twice weekly for 2weeks*Normal Prolactin level = 2.9-29 ng/ml

*Prolactinomas are responsible for >90% of pituitary causes of anovulation &

amenorrhea

*PCO has LH/FSH = 2/1 (which is abnormal)

*Rise in temp. in the 2nd half an ovulatory mens. Cycle = 0.2-0.3

*Midluteal serum progesterone is done 7 days after ovulation (at day 21 of the cycle)

*PEB is done 2-3 d. before menstruation

*Dose of CC = 50mg oral tablets twice daily for 5 d. starting from 5th day of the cycle

*Success rate of CC in induction of ovulation = 85%

*Dose of Tamoxifen : 10-40mg daily orally for 5 d. starting from the 2nd day of the cycle

*HMG contains 75IU FSH + 75IU LH*Purified FSH contains 75IU FSH + 1IU LH

*hCG is given as 2 ampoules 5000 m/IU each as a single IM inj.

*Incidence of PCOS = 5-10% of women in the reproductive age

*In LPD the luteal phase of the cycle is shortened to be < 11 d.

* Levels of P,E2,Prolactin,T,FSH,LH are all calculated in (ng)

*MPHG is sometimes associated with small ovarian follicular cyst < 5cm in diameter

*A cut-off value for endometrial thickness in menopause > 5mm is suspicious for

hyperplasia, and that > 10mm is suspicious for malignancy

*Anaerobes:Aerobes among vaginal flora = 10:1

*Normal vaginal pH = 3.8-4.5

*pH of vagina in BV = 4.7-7*50% of cases of BV are asymptomatic

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*Gardnerella Vaginalis may grow normally in the vagina of over than 50% of normal

women

*30% of cases of BV recur after treatment within 3 m.

*CDC regimen of BV :Metronidazole(tablets) 500 mg

Clindamycin(tablets) 300 mg

Metronidazole(gel) 5 g

Clindamycin(cream) 5 g

*About 30% of women have candidal colonization in their vagina with no symptoms

*Budding yeast under microscope is seen in 50-70% of yeast infected women

*CDC regimen of CV :

Topical : butaconazole 5g (3d.)-miconazole 5g(7d.)-nystatin(100,000 U)(14d.)

Oral : Fluconazole single oral dose(150mg)-Ketoconazole(in recurrent cases)

*Metronidazole in ttt of trichomoniasis is given 1 g orally

*Male sexual partner should be treated by metronidazole,otherwise he will be

reinfected by 25%

*Risk of prolapse increases by 1.2 times with each vaginal delivery

*Incidence = 20% of women over the age of 30 (1 in every 5 women)

*Corporeal fibroids represent 96% _ Cervical 4 %

*Sarcomatous in change of a myoma occurs in 0.2-0.5 % of cases

*30% of case of fibroid present with menorrhagia

*Small myoma gives a uterine size of < 12 w.,if more it indicates degeneration

*Medical ttt of fibroid is indicated when the uterus is < 12 w. , however surgical

management is indicated when it becomes > 14 w.

*Incidence of Endometriosis = 20 % of women in the childbearing period

*In mild cases of fibroid, but with severe symptoms, pseudopregnancy orpseudomenopause is created along a duration of 6m. to 2y.

*Male factor represents 30-40% of causes of infertility

*Female factor represents 40-50% of causes of infertility

*The cause of infertility is unexplained in 10-15% of cases

*Normal Semen parameters :

Vol. = 2-5 ml

Conc./ml = >20 million sperms/ml

Total spermatic count = >40 million/ml

Progression >50%

Motility >50%

Morphology >30% normal forms(oval head&single head)

WBC's < 1 milloion/ml

*Ovarian factor is the commonest cause of female infertility 30-40%

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*Decreased ovarian reserve is detected by high FSH level on dat 3 of the cycle

(>10ng/ml)

*HSG is performed 2-3 days after menses

*Post Coital Test is done 6-10 hours after intercourse

*Cu-T may be 380 or 200(Nova-T)

*Cu-T IUD is changed every 6-8 years*Mirena IUD is changed every 3-4 years

*IUD is inserted on the last day of menses,4-6 weeks after delivery & 3-4 weeks after

abortion

*IUD threads are cut 2 cm. from the ext. os

*Failure rate of IUD = 0.5/HWY

*Cu-IUD inc. blood loss by 35%

*Mirena dec. blood loss by 70%

*Abortion rate in pregnancy on IUD = 50% if threads are not seen & 25% if threads are

seen and IUD is removed

*COC monophasic pills are given on day 3 or 4 of menstruation for 21 d. followed by 7

d. free period , shedding occurs 3-4 d. after stopping COC

*Vaginal ring is applied on day 3-4 of menstruation for 21 d. followed by 7 d. ring free

period to allow withdrawal

*Contraceptive patches are given on day 3-4 of menstruation for 21 d. (changed every

one week) followed by 7 d. patch free period to allow withdrawal

*Failure rate of hormonal contraceptive method = 0.1-1/HWY

*Progestin only injectables are given every 3 m. IM

*Subdermal progestin Implants give 3 y. contraception

*During lactation 40-60% of women will experience amenorrhea&anovulation in the first

few months

*IUD is inserted post-coitaly for emergency contraception within 24-48 h.

*POP are given post-coital immediately as 1st dose followed by 2nd dose after 12 h.

*POP or COC are given within 72 h. after coitus for emergency contraception

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