ONE LINER IMP KEY POINTS.

Introduction to Midwifery and Obstetrical Nursing

a) Definition of Midwifery and Obstetrical Nursing

1. Midwifery involves care during pregnancy, childbirth, and postpartum.
2. Obstetrical nursing focuses on maternal and newborn health.
3. Midwifery promotes natural birth with minimal interventions.
4. Obstetrical nursing manages both normal and high-risk pregnancies.
5. Midwives provide physical, emotional, and educational support.
6. Obstetrical nurses assist in prenatal, intrapartum, and postnatal care.
7. Midwifery is both an art and science of childbirth care.
8. Obstetrical nursing includes family planning and reproductive health.
9. Midwives offer primary care for pregnant women in many countries.
10. Obstetrical nurses collaborate with doctors during labor and delivery.

b) Scope of Midwifery

11. Midwives provide antenatal care to monitor maternal health.
12. They manage normal labor and delivery processes.
13. Postnatal care is a key part of midwifery services.
14. Midwives support breastfeeding and newborn care.
15. They educate mothers about maternal and child health.
16. Family planning counseling is part of midwifery practice.
17. Midwives work in hospitals, clinics, and community settings.
18. They manage obstetric emergencies in resource-limited areas.
19. Midwives promote safe motherhood and reduce maternal mortality.
20. They play a role in reproductive and sexual health education.

c) Basic Competencies of a Midwife

21. Midwives must be skilled in antenatal assessments.
22. They can detect complications during pregnancy and labor.
23. Midwives manage normal deliveries independently.
24. They provide emergency care in obstetric complications.
25. Neonatal resuscitation is an essential midwifery skill.
26. Midwives counsel on family planning and contraception.
27. They offer psychological support to expectant mothers.
28. Midwives maintain accurate maternal and newborn records.
29. They ensure infection prevention during childbirth.
30. Midwives educate families about maternal and newborn care.

d) History of Midwifery

31. Midwifery dates back to ancient civilizations like Egypt and Greece.
32. Historically, midwives were traditional birth attendants.
33. The 17th century marked the start of formal midwifery training.
34. Modern midwifery evolved with advances in medical science.
35. Florence Nightingale influenced midwifery as part of nursing care.
36. In India, traditional midwives were known as “dais.”
37. The professionalization of midwifery began in the 20th century.
38. Midwifery education is now integrated into nursing programs.
39. WHO recognizes midwives as key to improving maternal health.
40. Midwifery continues to evolve with evidence-based practices.

e) Trends of Maternity Services in India

41. Increase in institutional deliveries under government schemes.
42. Janani Suraksha Yojana (JSY) promotes safe motherhood.
43. Training of Skilled Birth Attendants (SBAs) has expanded.
44. Introduction of midwifery-led care units in hospitals.
45. Focus on respectful maternity care to improve patient satisfaction.
46. Use of mobile health apps for antenatal care tracking.
47. Emphasis on high-risk pregnancy identification and referral.
48. Integration of maternal health into the RMNCH+A strategy.
49. Government programs focus on reducing maternal mortality.
50. Community-based interventions improve access to maternity services.

f) Vital Statistics Related to Maternal Health in India

51. Maternal Mortality Ratio (MMR): 97 per 100,000 live births (latest data).
52. Infant Mortality Rate (IMR): 28 per 1,000 live births.
53. Total Fertility Rate (TFR): 2.0, nearing replacement level.
54. Neonatal Mortality Rate (NMR): 20 per 1,000 live births.
55. Over 88% of births occur in healthcare institutions.
56. Over 80% of women receive four or more antenatal check-ups.
57. Skilled birth attendance rate is above 85%.
58. Postnatal care coverage within 48 hours is improving.
59. Anemia prevalence in pregnant women remains a major concern.
60. Government aims to reduce MMR below 70 per 100,000 live births by 2030.

Reproductive System

a) Review of Structure and Function of Female Reproductive System

1. The female reproductive system includes internal and external organs.
2. The ovaries produce ova (eggs) and secrete estrogen and progesterone.
3. The fallopian tubes transport the ovum from the ovary to the uterus.
4. Fertilization usually occurs in the ampulla of the fallopian tube.
5. The uterus is a muscular organ where the fertilized egg implants and grows.
6. The uterus has three layers: endometrium, myometrium, and perimetrium.
7. The endometrium thickens monthly for potential implantation.
8. The myometrium facilitates uterine contractions during labor.
9. The cervix is the lower part of the uterus opening into the vagina.
10. The vagina serves as the birth canal and the exit for menstrual flow.
11. The vulva includes external genitalia like labia majora, labia minora, clitoris, and vestibule.
12. The clitoris is highly sensitive and involved in female sexual arousal.
13. Bartholin’s glands secrete mucus to lubricate the vagina.
14. The menstrual cycle is regulated by hormones: FSH, LH, estrogen, and progesterone.
15. The average menstrual cycle is about 28 days.
16. Ovulation occurs around the 14th day of the menstrual cycle.
17. Estrogen promotes the development of secondary sexual characteristics.
18. Progesterone maintains the uterine lining for pregnancy.
19. The ovaries contain follicles that mature and release eggs during ovulation.
20. The corpus luteum forms after ovulation and secretes progesterone.
21. The broad ligament supports the uterus, fallopian tubes, and ovaries.
22. The round ligament helps maintain the anteverted position of the uterus.
23. The uterosacral ligament supports the uterus posteriorly.
24. The ovarian ligament connects the ovary to the uterus.
25. The hymen is a thin membrane partially covering the vaginal opening.

b) Female Pelvis – Structure, Types, and Diameters

26. The female pelvis is broader and shallower compared to the male pelvis.
27. The pelvis consists of the ilium, ischium, pubis, sacrum, and coccyx.
28. The pelvic brim divides the pelvis into the false pelvis and true pelvis.
29. The false pelvis supports abdominal organs.
30. The true pelvis is crucial for childbirth.
31. The inlet, cavity, and outlet are the three parts of the true pelvis.
32. The four types of female pelvis are gynecoid, android, anthropoid, and platypelloid.
33. The gynecoid pelvis is the most favorable for vaginal delivery.
34. The android pelvis is heart-shaped and less favorable for childbirth.
35. The anthropoid pelvis has an oval shape with a larger anteroposterior diameter.
36. The platypelloid pelvis is flat and least favorable for vaginal birth.
37. The pelvic inlet is bounded by the sacral promontory, arcuate line, and pubic symphysis.
38. The anteroposterior diameter of the pelvic inlet is about 11 cm.
39. The transverse diameter of the pelvic inlet is around 13 cm.
40. The oblique diameter of the pelvic inlet is about 12 cm.
41. The pelvic outlet is diamond-shaped.
42. The anteroposterior diameter of the pelvic outlet is about 9.5-11.5 cm.
43. The interspinous diameter is the narrowest part of the pelvic cavity.
44. The subpubic angle in females is wider (>80°) compared to males.
45. The sacrum in females is shorter, wider, and less curved.
46. The ischial spines are less prominent in the gynecoid pelvis, aiding childbirth.
47. The pelvic floor muscles support pelvic organs and assist in childbirth.
48. The levator ani muscle forms the major part of the pelvic floor.
49. The sacroiliac joints and pubic symphysis allow slight movement during childbirth.
50. Relaxin hormone helps loosen pelvic ligaments during pregnancy for delivery.

Embryology and Fetal Development

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a) Oogenesis, Spermatogenesis, Fertilization, and Implantation

1. Oogenesis is the process of egg (ovum) formation in females.
2. Oogenesis starts during fetal life and completes after puberty.
3. The primary oocyte undergoes meiosis I to form a secondary oocyte and a polar body.
4. The secondary oocyte completes meiosis II only if fertilization occurs.
5. Spermatogenesis is the process of sperm production in males.
6. Spermatogenesis occurs in the seminiferous tubules of the testes.
7. It starts at puberty and continues throughout life.
8. Spermatogenesis involves mitosis, meiosis, and spermiogenesis.
9. One primary spermatocyte forms four mature sperm cells.
10. Mature sperm has a head, midpiece, and tail for motility.
11. Fertilization usually occurs in the ampulla of the fallopian tube.
12. It is the fusion of the male sperm with the female ovum to form a zygote.
13. The zygote is diploid with 46 chromosomes.
14. Capacitation is the process that prepares sperm to penetrate the ovum.
15. The acrosomal reaction helps the sperm to penetrate the zona pellucida.
16. Polyspermy is prevented by cortical reactions after the first sperm entry.
17. The zygote undergoes cleavage to form a morula.
18. The morula develops into a blastocyst, which implants in the uterus.
19. Implantation occurs around 6-7 days after fertilization.
20. The blastocyst implants in the endometrial lining of the uterus.
21. The outer layer of the blastocyst forms the trophoblast, contributing to the placenta.
22. The inner cell mass of the blastocyst forms the embryo.
23. Successful implantation requires a receptive endometrium.
24. The hormone hCG (human chorionic gonadotropin) supports implantation.
25. Ectopic pregnancy occurs when implantation happens outside the uterus.

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b) Embryology and Fetal Development

26. Embryology is the study of development from fertilization to birth.
27. The embryonic period is from fertilization to the 8th week of gestation.
28. The fetal period starts from the 9th week until birth.
29. Organogenesis occurs during the embryonic period.
30. By the 4th week, the heart starts beating.
31. Limb buds appear by the 5th week.
32. The neural tube develops into the brain and spinal cord.
33. By 8 weeks, all major organs are formed.
34. The fetus starts moving (quickening) around the 16th-20th week.
35. Lanugo (fine hair) appears by the 20th week.
36. Vernix caseosa covers the fetal skin for protection.
37. By 24 weeks, surfactant production begins in the lungs.
38. Fetal viability improves after 28 weeks.
39. The fetus gains significant weight during the third trimester.
40. By 40 weeks, the fetus is fully mature for birth.
41. The amnion and chorion are protective fetal membranes.
42. Gastrulation forms the three germ layers: ectoderm, mesoderm, and endoderm.
43. The ectoderm forms the skin, brain, and nervous system.
44. The mesoderm forms muscles, bones, and the heart.
45. The endoderm forms the lining of the digestive and respiratory tracts.
46. Fetal sex can be determined by ultrasound around 18-20 weeks.
47. Teratogens are substances that cause birth defects.
48. Critical periods of development are when the fetus is most vulnerable to damage.
49. The umbilical cord connects the fetus to the placenta for nutrient exchange.
50. Fetal circulation differs from postnatal circulation due to shunts.

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c) Placenta and Membranes

Structure

51. The placenta is a disc-shaped organ formed from fetal and maternal tissues.
52. It has two sides: the maternal side (rough) and the fetal side (smooth).
53. The fetal side is covered by the amnion.
54. The placenta contains villi for nutrient and gas exchange.
55. The umbilical cord connects the fetus to the placenta.

Functions

56. The placenta supplies oxygen and nutrients to the fetus.
57. It removes waste products from fetal blood.
58. The placenta produces hormones like hCG, progesterone, and estrogen.
59. It acts as a protective barrier against some infections.
60. The placenta facilitates immune tolerance during pregnancy.
61. It transfers antibodies from mother to fetus for passive immunity.

Abnormalities

62. Placenta previa is when the placenta covers the cervix.
63. Placental abruption is the premature separation of the placenta from the uterus.
64. Placenta accreta occurs when the placenta attaches too deeply into the uterine wall.
65. Inadequate placental function can lead to fetal growth restriction.

Liquor Amnii (Amniotic Fluid)

66. Amniotic fluid cushions the fetus and protects against trauma.
67. It helps maintain a stable temperature for the fetus.
68. The fetus swallows and urinates into the amniotic fluid.
69. Normal volume at term is around 500-1000 mL.
70. Oligohydramnios is decreased amniotic fluid volume.
71. Polyhydramnios is excessive amniotic fluid volume.

Umbilical Cord

72. The umbilical cord has two arteries and one vein.
73. The umbilical vein carries oxygenated blood to the fetus.
74. The umbilical arteries carry deoxygenated blood to the placenta.
75. The cord is protected by Wharton’s jelly.
76. Cord abnormalities include knots, short cords, and nuchal cords (wrapped around the neck).

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d) Fetal Skull

Structure

77. The fetal skull consists of the vault, base, and face.
78. The vault is flexible to allow molding during birth.
79. It consists of frontal, parietal, occipital, and temporal bones.

Diameters

80. The biparietal diameter (9.5 cm) is the widest part of the fetal head.
81. The suboccipitobregmatic diameter (9.5 cm) is ideal for vaginal delivery.
82. The occipitofrontal diameter is about 11.5 cm.
83. The mentovertical diameter measures around 13.5 cm.
84. The diameters change due to molding during labor.

Fontanels and Sutures

85. The anterior fontanel is diamond-shaped and closes by 18 months.
86. The posterior fontanel is triangular and closes by 6-8 weeks.
87. Sutures are flexible joints between the skull bones.
88. The main sutures are sagittal, coronal, lambdoid, and frontal.
89. Sutures and fontanels allow overlap during birth.
90. A bulging fontanel may indicate increased intracranial pressure.
91. A sunken fontanel may indicate dehydration.

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e) Fetal Circulation

92. Fetal circulation differs from postnatal circulation due to shunts.
93. Oxygenated blood comes from the placenta via the umbilical vein.
94. The ductus venosus bypasses the liver to send blood to the inferior vena cava.
95. The foramen ovale allows blood to flow from the right atrium to the left atrium.
96. The ductus arteriosus connects the pulmonary artery to the aorta.
97. Most blood bypasses the fetal lungs as they are non-functional in utero.
98. Deoxygenated blood returns to the placenta via umbilical arteries.
99. After birth, the foramen ovale closes due to pressure changes.
100. The ductus arteriosus closes within the first few days after birth.
101. The ductus venosus closes and becomes the ligamentum venosum.
102. The foramen ovale becomes the fossa ovalis.
103. The ductus arteriosus becomes the ligamentum arteriosum.
104. The umbilical vein becomes the ligamentum teres of the liver.
105. The umbilical arteries become medial umbilical ligaments.
106. The fetal heart starts beating by the 4th week of development.
107. Fetal hemoglobin (HbF) has a higher oxygen affinity than adult hemoglobin.
108. The fetal liver receives limited blood due to the ductus venosus.
109. Pulmonary circulation is minimal before birth.
110. The placenta acts as the organ for gas exchange in the fetus.

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Additional Quick Facts for Revision

111. Implantation usually occurs in the upper posterior wall of the uterus.
112. The yolk sac provides early nutrition to the embryo.
113. The chorion contributes to placental development.
114. Dizygotic twins arise from two separate eggs.
115. Monozygotic twins arise from a single fertilized egg.
116. Neural tube defects can be prevented with folic acid supplementation.
117. The umbilical cord is around 50-60 cm long at term.
118. Amniocentesis is done to analyze fetal genetic conditions.
119. The placenta is fully functional by the end of the first trimester.
120. The umbilical vein carries oxygen-rich blood to the fetus.
121. Placenta previa presents with painless vaginal bleeding.
122. Abruptio placentae presents with painful vaginal bleeding.
123. The fetal heart rate ranges between 110-160 bpm.
124. The ductus arteriosus functionally closes after birth due to oxygen exposure.
125. Surfactant reduces surface tension in the lungs, aiding breathing after birth.
126. Polyhydramnios is associated with fetal anomalies like anencephaly.
127. Oligohydramnios is linked with renal anomalies in the fetus.
128. Fetal breathing movements occur in utero as practice for birth.
129. Crown-rump length is used for early pregnancy dating.
130. Nuchal translucency measurement helps detect chromosomal abnormalities.
131. The fetus starts producing urine by the 12th week.
132. The umbilical cord may have a true knot or false knot.
133. The corpus luteum supports pregnancy until the placenta takes over.
134. The decidua basalis forms the maternal part of the placenta.
135. Placental insufficiency can lead to intrauterine growth restriction (IUGR).
136. The amniotic fluid is constantly produced and reabsorbed.
137. Lanugo disappears by the third trimester.
138. The fetus can hear sounds from around 20 weeks gestation.
139. The fetal lungs remain fluid-filled until birth.
140. Vernix caseosa protects the fetal skin from amniotic fluid.
141. The umbilical cord insertion can be central, marginal, or velamentous.
142. The placenta produces progesterone to maintain pregnancy.
143. The foramen ovale allows right-to-left shunting of blood.
144. The ductus arteriosus diverts blood away from the non-functioning fetal lungs.
145. The primitive streak forms during early embryonic development.
146. The notochord induces the formation of the neural tube.
147. The embryo is most vulnerable to teratogens during organogenesis.
148. The corpus callosum develops from the ectoderm.
149. The liver is the main site of hematopoiesis in the fetus.
150. Fetal circulation closes shunts after birth to establish adult circulation.

Normal Pregnancy and Its Management.

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a) Pre-Conception Care

1. Pre-conception care optimizes health before pregnancy.
2. Folic acid supplementation reduces neural tube defects.
3. Control of chronic diseases improves pregnancy outcomes.
4. Rubella vaccination should be given before pregnancy if non-immune.
5. Screening for STIs reduces risks of congenital infections.
6. Maintaining a healthy BMI improves fertility and reduces complications.
7. Smoking cessation decreases the risk of preterm birth.
8. Avoid alcohol and drugs to prevent fetal anomalies.
9. Review of medications is crucial to avoid teratogens.
10. Genetic history helps identify inherited disorders.
11. Diabetic control reduces congenital malformations.
12. Ensuring up-to-date immunizations protects both mother and fetus.
13. Thyroid function tests are important in women with thyroid disorders.
14. Iron and vitamin D status should be checked and corrected.
15. Dental check-ups are recommended before conception.
16. Mental health screening supports emotional well-being.
17. Assess for domestic violence as part of routine care.
18. Counsel on safe physical activity pre-pregnancy.
19. Avoid radiation exposure during the conception period.
20. Genetic counseling is advised for couples with a family history of genetic disorders.

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b) Genetic Counseling

21. Genetic counseling helps assess the risk of inherited conditions.
22. It is essential for couples with a family history of genetic disorders.
23. Consanguineous marriages have higher genetic risks.
24. Carrier screening identifies carriers of genetic diseases.
25. Prenatal testing includes amniocentesis and chorionic villus sampling.
26. Non-invasive prenatal testing (NIPT) screens for chromosomal abnormalities.
27. Down syndrome risk increases with maternal age.
28. Karyotyping detects chromosomal abnormalities.
29. Ultrasound can identify structural anomalies.
30. Genetic disorders include thalassemia, sickle cell anemia, and cystic fibrosis.
31. Pedigree analysis helps trace inheritance patterns.
32. Autosomal recessive disorders require both parents to be carriers.
33. X-linked disorders primarily affect males.
34. Genetic counseling supports informed reproductive decisions.
35. Preimplantation genetic diagnosis (PGD) is used in IVF for genetic screening.
36. Genetic mutations can be spontaneous or inherited.
37. Gene therapy is an emerging field for treating genetic diseases.
38. Ethical issues are integral to genetic counseling.
39. Multidisciplinary teams often support genetic counseling.
40. Psychological support is crucial during genetic counseling.

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c) Physiological Changes in Pregnancy

41. Blood volume increases by 30-50% during pregnancy.
42. Cardiac output rises to meet fetal demands.
43. Heart rate increases by 10-15 beats per minute.
44. Blood pressure slightly decreases in the second trimester.
45. Plasma volume expansion leads to physiological anemia.
46. White blood cell count increases naturally during pregnancy.
47. Clotting factors increase, raising the risk of thrombosis.
48. Progesterone causes relaxation of smooth muscles.
49. Heartburn is common due to relaxed esophageal sphincter.
50. Respiratory rate remains unchanged, but tidal volume increases.
51. Shortness of breath is common due to increased oxygen demand.
52. Renal blood flow increases, enhancing filtration.
53. Frequent urination occurs due to pressure on the bladder.
54. Melasma (mask of pregnancy) causes skin pigmentation changes.
55. Linea nigra is a dark line on the abdomen.
56. Stretch marks (striae gravidarum) are common in pregnancy.
57. Gingival hyperplasia can cause swollen gums.
58. Nausea and vomiting occur due to hCG hormone.
59. Breast enlargement prepares for lactation.
60. Back pain results from postural changes.
61. Edema occurs due to fluid retention.
62. Leg cramps are common due to electrolyte imbalance.
63. Increased basal metabolic rate (BMR) supports fetal growth.
64. Mood swings are influenced by hormonal changes.
65. Hyperpigmentation affects areolas, face, and abdomen.
66. Increased vaginal discharge is normal in pregnancy.
67. Relaxin hormone loosens ligaments in preparation for birth.
68. Constipation occurs due to reduced gut motility.
69. Hemorrhoids are common from increased pelvic pressure.
70. Anemia of pregnancy is physiological due to hemodilution.

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d) Diagnosis of Pregnancy

History

71. Missed period is often the first sign of pregnancy.
72. Nausea and vomiting (morning sickness) are common early symptoms.
73. Breast tenderness is an early pregnancy symptom.
74. Fatigue is frequently reported in early pregnancy.
75. Increased urination occurs due to hormonal changes.

Signs & Symptoms

76. Chadwick’s sign: bluish discoloration of the cervix.
77. Goodell’s sign: softening of the cervix.
78. Hegar’s sign: softening of the uterine isthmus.
79. Piskacek’s sign: asymmetrical enlargement of the uterus.
80. Braxton Hicks contractions: irregular, painless uterine contractions.
81. Positive pregnancy test detects hCG in urine or blood.
82. Fetal heart sounds heard by Doppler after 10-12 weeks.
83. Ultrasound confirms intrauterine pregnancy.
84. Fetal movements felt by the mother after 18-20 weeks (quickening).
85. Abdominal enlargement corresponds with gestational age.

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e) Antenatal Care

History Taking

86. Obstetric history includes gravidity, parity, and past pregnancy outcomes.
87. Menstrual history helps determine the last menstrual period (LMP).
88. Medical history identifies chronic conditions affecting pregnancy.
89. Family history screens for genetic disorders.
90. Social history assesses support systems and lifestyle factors.

Calculation of Expected Date of Delivery (EDD)

91. Naegele’s rule: LMP + 9 months + 7 days = EDD.
92. A normal pregnancy lasts around 280 days (40 weeks).
93. Ultrasound is accurate for dating pregnancy in the first trimester.

Examination and Investigations

94. General examination includes weight, BP, and pulse.
95. Abdominal examination assesses uterine size and fetal growth.
96. Fundal height measurement helps track fetal growth.
97. Leopold’s maneuvers determine fetal position.
98. Pelvic examination assesses the cervix and pelvic adequacy.
99. Blood tests include CBC, blood group, Rh factor, and sugar levels.
100. Urine tests check for protein, sugar, and infections.
101. Ultrasound monitors fetal growth and detects anomalies.
102. Glucose tolerance test screens for gestational diabetes.
103. HIV, hepatitis B, and syphilis screening is routine.

Health Education and Counselling

104. Educate on nutrition, including iron, calcium, and folic acid intake.
105. Counsel on danger signs like bleeding, severe headaches, or decreased fetal movements.
106. Encourage regular antenatal visits for monitoring.
107. Promote physical activity suitable for pregnancy.
108. Advise on birth preparedness and emergency planning.

Drugs and Immunizations

109. Iron and folic acid supplements prevent anemia.
110. Tetanus toxoid (TT) vaccine prevents neonatal tetanus.
111. Influenza vaccine is recommended during pregnancy.
112. Rho(D) immune globulin is given to Rh-negative mothers.
113. Avoid teratogenic drugs during pregnancy.

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f) Minor Disorders and Their Management

114. Nausea and vomiting: manage with small, frequent meals.
115. Heartburn: avoid spicy foods and eat upright.
116. Constipation: increase fiber and fluid intake.
117. Back pain: practice good posture and gentle exercises.
118. Leg cramps: stretch muscles and maintain hydration.
119. Edema: elevate legs and avoid prolonged standing.
120. Varicose veins: wear compression stockings.
121. Fatigue: rest adequately and maintain a balanced diet.
122. Increased urination: normal but rule out UTIs if painful.
123. Dizziness: avoid sudden position changes.
124. Nasal congestion: due to hormonal changes; use saline drops.
125. Skin pigmentation changes: reassure as they fade postpartum.
126. Breast tenderness: wear supportive bras.
127. Mood swings: provide emotional support and counseling.
128. Frequent headaches: manage with rest and hydration (rule out preeclampsia).
129. Bleeding gums: maintain oral hygiene.
130. Stretch marks: moisturizers may help, though not preventable.
131. Hemorrhoids: manage constipation and use sitz baths.
132. Frequent colds: due to reduced immunity; rest and fluids help.
133. Itchy skin: moisturizers and antihistamines (if severe).
134. Palpitations: common but evaluate if persistent.
135. Mild shortness of breath: normal due to diaphragm elevation.
136. Round ligament pain: gentle stretching can relieve discomfort.
137. Urinary incontinence: pelvic floor exercises help.
138. Acne: avoid harsh treatments; consult a doctor.
139. Sleep disturbances: side-lying positions improve comfort.
140. Increased vaginal discharge: normal unless foul-smelling.
141. Mild swelling: normal in late pregnancy but monitor for preeclampsia.
142. Frequent hunger: eat balanced, small meals.
143. Bloating: avoid gas-producing foods.
144. Cravings: normal unless non-food items (pica).
145. Dry eyes: artificial tears can help.
146. Sensitive gums: gentle brushing recommended.
147. Urinary tract infections (UTIs): treat promptly with antibiotics.
148. Abdominal discomfort: usually due to stretching; rule out complications.
149. Mild anemia: managed with iron supplements.
150. Mild hypertension: monitor closely to detect preeclampsia.
151. Dyspepsia: antacids can provide relief.
152. Bitter taste: common in early pregnancy.
153. Allergic reactions: antihistamines if prescribed.
154. Dehydration: increase fluid intake.
155. Frequent colds and coughs: saline sprays and rest.
156. Thigh pain: due to nerve compression, mild stretching helps.
157. Pelvic pain: due to ligament stretching, warm compress helps.
158. Rashes: consult a doctor to rule out infections.
159. Mild depression: counseling and support groups help.
160. Mild anemia: ensure iron and folic acid supplementation.
161. Gastritis: small meals and avoiding spicy foods help.
162. Puffy face: evaluate for preeclampsia if severe.
163. Excessive saliva: frequent small sips of water.
164. Low back pain: maternity belts may provide support.
165. Flatulence: avoid carbonated drinks.
166. Skin tags: common and harmless during pregnancy.
167. Mild breathlessness: normal unless associated with chest pain.
168. Ear congestion: normal, due to increased blood flow.
169. Mild fever: rule out infections, consult a doctor.
170. Sore throat: saltwater gargles help.
171. Hip pain: gentle stretches and warm compresses.
172. Mild dizziness: sit down immediately to avoid falls.
173. Chapped lips: use lip balm and stay hydrated.
174. Dry skin: use moisturizing creams.
175. Joint pain: light exercise and rest.
176. Puffy hands: elevate when resting.
177. Frequent sneezing: common due to hormonal changes.
178. Mild vision changes: normal but consult if severe.
179. Numbness in hands: carpal tunnel syndrome, wrist splints help.
180. Mild chest discomfort: rule out heart conditions if severe.
181. Mild diarrhea: stay hydrated and consult if persistent.
182. Swollen ankles: elevate legs while resting.
183. Mild tremors: consult if persistent, rule out thyroid issues.
184. Frequent hiccups: usually harmless.
185. Brittle nails: maintain good nutrition.
186. Sweating: common due to increased metabolism.
187. Frequent yawning: due to fatigue, ensure rest.
188. Eye dryness: use lubricating drops if needed.
189. Slight vaginal bleeding: consult immediately to rule out complications.
190. Groin pain: due to ligament stretching.
191. Mild temperature fluctuations: consult if associated with infection.
192. Mild memory issues: “pregnancy brain” is common.
193. Bleeding gums: due to increased vascularity.
194. Low libido: normal due to hormonal changes.
195. Nosebleeds: common, use humidifiers.
196. Weight gain: normal; monitor for healthy growth.
197. Mild heart palpitations: common but consult if severe.
198. Itchy palms and soles: consult to rule out cholestasis.
199. Mild headaches: rest and hydration help.
200. Unusual dreams: common due to hormonal changes.

Normal Labour and Its Management.

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a) Definition and Stages of Labour

1. Labour is the process of expelling the fetus, placenta, and membranes from the uterus.
2. It involves regular uterine contractions leading to cervical changes.
3. The first stage starts from the onset of true labour to full cervical dilatation (10 cm).
4. The second stage lasts from full dilatation to the delivery of the baby.
5. The third stage is from the delivery of the baby to the expulsion of the placenta.
6. The fourth stage is the immediate postpartum period (first 1-2 hours after placenta delivery).
7. Labour is considered normal if it starts spontaneously, progresses without complications, and results in vaginal delivery.
8. The latent phase of the first stage involves slow cervical dilation up to 4 cm.
9. The active phase involves rapid cervical dilation from 4 to 10 cm.
10. The second stage includes the descent of the baby through the birth canal.

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b) Causes and Signs of Onset of Labour

11. Labour is initiated by complex hormonal interactions, including oxytocin and prostaglandins.
12. Uterine stretch from fetal growth triggers contractions.
13. Progesterone withdrawal allows for uterine contractions.
14. Fetal cortisol may play a role in the onset of labour.
15. True labour involves regular, painful contractions leading to cervical changes.
16. Bloody show (mucus mixed with blood) indicates cervical effacement.
17. Rupture of membranes can signal the onset of labour.
18. Backache and cramping are common early signs of labour.
19. Pelvic pressure increases as the baby descends.
20. Contractions become stronger, longer, and more frequent during true labour.

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c) True and False Labour

21. True labour causes progressive cervical dilation and effacement.
22. False labour (Braxton Hicks contractions) does not lead to cervical changes.
23. True labour contractions are regular, while false labour contractions are irregular.
24. True labour contractions intensify with activity; false labour may ease with rest.
25. Pain in true labour starts in the back and radiates to the abdomen.
26. False labour pain is usually felt only in the lower abdomen.
27. In true labour, the cervix dilates and effaces; in false labour, it remains unchanged.
28. Hydration and rest often relieve false labour contractions.
29. Membrane rupture is associated with true labour.
30. In false labour, contractions do not follow a predictable pattern.

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d) First Stage of Labour

Physiology

31. The first stage involves cervical effacement and dilation.
32. Uterine contractions cause the retraction of muscle fibers.
33. The fetal head descends, applying pressure to the cervix.
34. The “show” occurs due to the rupture of small cervical blood vessels.
35. The latent phase is slower; the active phase shows rapid dilation.

Monitoring Using Partograph and Its Interpretation

36. A partograph is used to monitor labour progress.
37. It tracks cervical dilation, fetal heart rate, contractions, and maternal vitals.
38. The alert line indicates normal progress in active labour.
39. The action line signals the need for intervention if crossed.
40. Contraction frequency is plotted as shaded boxes.
41. Fetal heart rate should be between 110-160 bpm.
42. Maternal pulse, BP, and temperature are recorded regularly.
43. Partograph helps in early detection of labour abnormalities.
44. Slow progress beyond the alert line indicates possible dystocia.
45. Crossing the action line requires evaluation for cesarean section.

Care of Mother: Physical and Psychological

46. Provide emotional support and reassurance.
47. Encourage ambulation if no contraindications.
48. Ensure adequate hydration and light nutrition.
49. Maintain bladder emptying every 2-3 hours.
50. Use relaxation techniques for coping with labour pains.
51. Provide a calm, private environment for the mother.
52. Offer continuous labour support from a birth companion.
53. Monitor for signs of distress in mother and baby.
54. Maintain infection control practices.
55. Address the mother’s concerns and anxieties.

Pain Management

56. Non-pharmacological methods include breathing exercises.
57. Warm baths and massage help relieve pain.
58. Position changes can ease discomfort.
59. Epidural analgesia provides effective pain relief.
60. Entonox (nitrous oxide) is used for mild pain relief.
61. Opioids like pethidine are used cautiously.
62. Ensure informed consent for any pain relief method.
63. Encourage relaxation techniques and focused breathing.
64. Distraction techniques like music can reduce perception of pain.
65. Acupressure is helpful in some cases for pain relief.

Setting Up the Labour Room Including Newborn Corner

66. A clean, well-lit labour room is essential.
67. Ensure sterile equipment for delivery is ready.
68. Prepare oxytocin for managing the third stage.
69. Have resuscitation equipment ready for the newborn.
70. The newborn corner should have a warmer.
71. Ensure availability of suction devices for newborn airway.
72. Check for oxygen supply and masks for emergencies.
73. Gloves, sterile drapes, and instruments should be arranged.
74. Delivery packs should be readily available.
75. Ensure cord clamps and scissors are sterilized.

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e) Second Stage of Labour

Physiology and Mechanism

76. The second stage starts from full dilation to the delivery of the baby.
77. Strong uterine contractions aid in fetal descent.
78. The mother feels the urge to push.
79. The mechanism of labour includes engagement, descent, flexion, internal rotation, extension, restitution, and expulsion.
80. Perineal bulging and crowning occur as the head emerges.

Monitoring

81. Monitor fetal heart rate every 5 minutes.
82. Observe for signs of fetal distress.
83. Check the descent of the head during contractions.
84. Assess maternal effort during pushing.
85. Monitor for signs of maternal exhaustion.

Conduction of Normal Delivery

86. Practice hand hygiene and use sterile techniques.
87. Support the perineum to prevent tears.
88. Guide the head gently during crowning.
89. Check for the presence of a nuchal cord.
90. Deliver the shoulders by gentle traction.
91. Clear the airway if needed after birth.
92. Dry the baby and maintain warmth.
93. Place the baby on the mother’s chest for skin-to-skin contact.
94. Clamp and cut the umbilical cord after it stops pulsating.
95. Initiate breastfeeding within the first hour.

Episiotomy

96. An episiotomy is a surgical incision to enlarge the vaginal opening.
97. Mediolateral episiotomy is the most common type.
98. Lignocaine is used for local anesthesia.
99. It helps prevent severe perineal tears.
100. Suturing is done after placenta delivery using absorbable sutures.

Essential Newborn Care

101. Ensure the baby is breathing well.
102. Provide thermal protection to prevent hypothermia.
103. Clear the airway if there’s obstruction.
104. Encourage early breastfeeding.
105. Assess APGAR score at 1 and 5 minutes.
106. Weigh the newborn.
107. Check for congenital anomalies.
108. Administer vitamin K injection to prevent bleeding.
109. Apply eye prophylaxis to prevent infections.
110. Provide cord care to prevent infection.

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f) Third Stage of Labour

Physiology and Signs

111. The third stage involves placental separation and expulsion.
112. Uterine contractions cause the placenta to detach.
113. Signs of separation include gush of blood, lengthening of the cord, and a firm uterus.
114. The placenta usually delivers within 5-30 minutes.
115. Delayed third stage increases the risk of postpartum hemorrhage.

Active Management of Third Stage (AMTSL)

116. Administer 10 IU oxytocin immediately after birth.
117. Perform controlled cord traction to deliver the placenta.
118. Uterine massage helps contract the uterus after placenta delivery.
119. Reduces the risk of postpartum hemorrhage (PPH).
120. Early cord clamping is practiced in AMTSL.

Examination of the Placenta

121. Check for complete expulsion of the placenta and membranes.
122. Examine the maternal surface for missing cotyledons.
123. Inspect the fetal surface and cord insertion.
124. Ensure no retained fragments to prevent PPH.
125. Placental abnormalities may indicate fetal complications.

Episiotomy Suturing

126. Use absorbable sutures for repair.
127. Clean the area with antiseptic solution.
128. Ensure adequate anesthesia before suturing.
129. Repair in layers: vaginal mucosa, muscle, and skin.
130. Check for bleeding post-suturing.

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g) Fourth Stage of Labour

Physiology

131. This stage involves uterine contraction stabilization.
132. Risk of postpartum hemorrhage is highest in this stage.
133. The uterus should be firm and contracted.
134. Normal involution begins immediately after delivery.
135. Mother may experience chills after delivery.

Care of the Mother and Baby

136. Monitor vital signs every 15 minutes for the first hour.
137. Check for uterine firmness and vaginal bleeding.
138. Assess the perineal area for bleeding or hematoma.
139. Encourage breastfeeding to stimulate oxytocin.
140. Provide emotional support to the mother.
141. Ensure skin-to-skin contact continues.
142. Monitor the newborn’s temperature and breathing.
143. Provide warmth to prevent neonatal hypothermia.
144. Observe for signs of infection in both mother and baby.
145. Check the bladder for retention.

Postpartum Family Planning

146. Discuss contraceptive options before discharge.
147. Lactational amenorrhea method (LAM) is effective with exclusive breastfeeding.
148. Condoms are safe immediately postpartum.
149. Progestin-only pills can be started after 6 weeks if breastfeeding.
150. Intrauterine devices (IUDs) can be inserted immediately postpartum.
151. Permanent methods like tubal ligation can be discussed.
152. Address cultural beliefs around family planning.
153. Involve the partner in family planning discussions.
154. Provide counseling on birth spacing for maternal health.
155. Discuss emergency contraception if needed.
156. Emphasize the importance of postpartum visits.
157. Family planning reduces risks of unintended pregnancies.
158. Educate on exclusive breastfeeding as a temporary contraceptive.
159. Address myths and misconceptions about contraception.
160. Offer referrals for long-term family planning methods.

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Bonus: Quick Revision Facts

161. First stage of labour: Onset of contractions to full dilation (10 cm).
162. Second stage: Full dilation to delivery of the baby.
163. Third stage: Delivery of the baby to the expulsion of the placenta.
164. Fourth stage: Immediate postpartum recovery period.
165. Active management reduces postpartum hemorrhage.
166. Partograph helps monitor labour progress.
167. Oxytocin prevents postpartum bleeding.
168. Episiotomy prevents uncontrolled perineal tears.
169. Essential newborn care includes warmth, airway, and breastfeeding.
170. Postpartum hemorrhage (PPH) is the leading cause of maternal death.
171. Uterine massage helps prevent atony.
172. Family planning is key to postpartum care.
173. Apgar score assesses newborn condition at 1 and 5 minutes.
174. Skin-to-skin contact promotes bonding and breastfeeding.
175. Kangaroo mother care is essential for low-birth-weight infants.
176. Breastfeeding should start within the first hour.
177. Neonatal resuscitation requires immediate readiness.
178. Fetal heart rate monitoring is crucial in labour.
179. Umbilical cord care prevents neonatal infections.
180. Perineal care reduces postpartum infections.
181. Monitor for postpartum depression signs.
182. Hydration and nutrition are important postpartum.
183. Lochia changes from red to pink to white postpartum.
184. Maternal vitals should be checked frequently after delivery.
185. Breast care prevents mastitis.
186. Postpartum anemia should be treated with iron supplements.
187. Kegel exercises strengthen pelvic floor postpartum.
188. Postnatal checkups detect complications early.
189. Diabetes and hypertension should be monitored postpartum.
190. Rh-negative mothers may need anti-D immunoglobulin.
191. Tetanus vaccination protects both mother and baby.
192. Newborn screening detects metabolic disorders.
193. Jaundice monitoring is essential in newborns.
194. Hypothermia prevention is critical in neonates.
195. Exclusive breastfeeding recommended for the first 6 months.
196. Delayed cord clamping improves neonatal iron stores.
197. Neonatal sepsis is a leading cause of infant mortality.
198. Maternal mental health requires attention postpartum.
199. Resuscitation equipment must be ready in the labour room.
200. Early postpartum discharge requires thorough counseling.
201. Uterine involution is assessed postpartum.
202. Iron supplementation continues after delivery.
203. Breastfeeding helps contract the uterus postpartum.
204. Postpartum blues are common but transient.
205. Persistent bleeding postpartum requires immediate attention.
206. Folic acid prevents neural tube defects.
207. Newborn hearing screening identifies early hearing loss.
208. Weight monitoring is essential in newborn care.
209. Phototherapy is used to treat neonatal jaundice.
210. Newborn vaccinations include BCG, OPV, and Hepatitis B.
211. Congenital anomalies require early detection.
212. Postpartum infections need prompt treatment.
213. Postpartum exercises improve recovery.
214. Perineal hygiene prevents infections.
215. Pelvic floor dysfunction is a postpartum concern.
216. Newborn reflexes indicate neurological health.
217. Suction equipment is crucial for newborn resuscitation.
218. Perineal tears are classified from first to fourth degree.
219. Breast engorgement is common postpartum.
220. Exclusive breastfeeding reduces infant mortality.
221. Mastitis requires antibiotics if infected.
222. Postpartum contraception can be initiated early.
223. Preeclampsia can persist postpartum.
224. Postpartum hemorrhage management includes uterotonics.
225. Early ambulation reduces thrombosis risk.
226. Umbilical granuloma may occur in newborns.
227. Postpartum depression requires screening and support.
228. Newborn temperature regulation is critical.
229. Hand hygiene prevents neonatal infections.
230. Cesarean section has specific postpartum care needs.
231. Postpartum follow-up should occur within 6 weeks.
232. Exclusive breastfeeding promotes maternal weight loss.
233. Maternal bonding strengthens through skin-to-skin contact.
234. Gestational diabetes may resolve postpartum.
235. Infant immunizations begin at birth.
236. Postpartum thyroiditis can occur.
237. Postpartum fatigue is common and should be addressed.
238. Perinatal mental health is vital for family well-being.
239. Placental examination detects abnormalities.
240. Postpartum infections often present with fever.
241. Lochia should decrease gradually postpartum.
242. Breastfeeding difficulties may need lactation support.
243. Urinary retention is a postpartum complication.
244. Postpartum hemorrhage may require surgical intervention.
245. Breastfeeding reduces the risk of ovarian cancer.
246. Newborn screening tests detect metabolic disorders.
247. Postpartum exercise improves physical recovery.
248. Mother-baby bonding promotes emotional health.
249. Postpartum anemia can cause fatigue.
250. Infant growth monitoring is essential.
251. Exclusive breastfeeding protects against infections.
252. Newborn hearing test detects early hearing loss.
253. Postpartum care reduces maternal mortality.
254. Breastfeeding delays return of menstruation.
255. Family planning should be discussed postpartum.
256. Newborn resuscitation requires skilled staff.
257. Iron supplements support recovery after birth.
258. Maternal depression impacts child development.
259. Vitamin K injection prevents bleeding in newborns.
260. Safe sleeping position reduces SIDS risk.
261. Neonatal jaundice should be monitored closely.
262. Breastfeeding support improves success rates.
263. Newborn screening includes metabolic disorders.
264. Postpartum checkups ensure maternal recovery.
265. Delayed cord clamping improves iron stores.
266. Handwashing prevents infections.
267. Postpartum care includes mental health support.
268. Breastfeeding benefits both mother and baby.
269. Family support is crucial postpartum.
270. Vitamin D supplementation may be needed for newborns.
271. Neonatal sepsis can be life-threatening.
272. Newborn temperature monitoring prevents hypothermia.
273. Exclusive breastfeeding is recommended for 6 months.
274. Postpartum anemia needs treatment.
275. Preeclampsia may persist postpartum.
276. Postpartum exercise improves well-being.
277. Safe sleep practices reduce SIDS.
278. Infant immunization protects against diseases.
279. Breastfeeding promotes maternal bonding.
280. Mental health screening postpartum is important.
281. Vitamin K prevents bleeding in newborns.
282. Skin-to-skin contact regulates newborn temperature.
283. Newborn screening identifies early disorders.
284. Maternal depression affects infant health.
285. Postpartum hemorrhage needs prompt management.
286. Breastfeeding reduces maternal cancer risk.
287. Neonatal jaundice may require phototherapy.
288. Family planning postpartum is essential.
289. Iron supplements prevent postpartum anemia.
290. Breastfeeding reduces infant infections.
291. Maternal health improves with postpartum care.
292. Newborn reflexes indicate neurological health.
293. Postpartum follow-up is important for recovery.
294. Exclusive breastfeeding promotes immunity.
295. Newborn vaccinations start at birth.
296. Postpartum mental health affects family well-being.
297. Infant growth monitoring is essential.
298. Breastfeeding provides optimal nutrition.
299. Postpartum recovery includes mental health support.
300. Family planning reduces maternal risks.

Management of Newborn.

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a) Assessment of Newborn

1. Newborn assessment begins immediately after birth.
2. Apgar score is assessed at 1 and 5 minutes after birth.
3. General appearance includes tone, activity, and color.
4. Check breathing pattern for signs of distress.
5. Assess heart rate; normal is 110–160 bpm.
6. Monitor temperature to prevent hypothermia.
7. Observe for cyanosis or pallor indicating poor oxygenation.
8. Check capillary refill time (<3 seconds) for perfusion.
9. Crying indicates healthy lung function.
10. Assess muscle tone; floppy tone may indicate issues.
11. Check head circumference for normal growth.
12. Assess for birth injuries like fractures or bruises.
13. Check the umbilical cord for 2 arteries and 1 vein.
14. Evaluate reflexes like sucking, rooting, and Moro reflex.
15. Assess weight, length, and head-to-toe for abnormalities.
16. Monitor for jaundice within the first 24 hours.
17. Observe for nasal flaring, a sign of respiratory distress.
18. Check for abdominal distension or masses.
19. Assess for congenital deformities (e.g., cleft lip, clubfoot).
20. Monitor urination and stooling within 24 hours.

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b) Physiological Adaptation of Newborn

21. Lung expansion occurs with the first breath.
22. Closure of fetal shunts (ductus arteriosus, foramen ovale) post-birth.
23. Newborn shifts from placental to pulmonary gas exchange.
24. Heart rate stabilizes at 120–160 bpm.
25. Thermoregulation develops to maintain body temperature.
26. Brown fat metabolism helps in heat production.
27. Glucose homeostasis adjusts post-delivery.
28. Bilirubin metabolism matures, reducing jaundice risk.
29. Renal function begins independently after birth.
30. Immune adaptation occurs with maternal antibody transfer.
31. Gastrointestinal function activates with feeding.
32. Meconium passage occurs within 24–48 hours.
33. Hepatic function starts bilirubin processing.
34. Circulatory system adapts to oxygenated blood via lungs.
35. Thermal stress is a risk due to immature skin barrier.
36. Neonatal reflexes indicate neurological health.
37. Immature immunity makes newborns prone to infections.
38. Surfactant production prevents alveolar collapse.
39. Skin color changes from bluish to pink as circulation improves.
40. Weight loss of 5-10% is normal in the first week.

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c) Apgar Scoring

41. Apgar score assesses newborn’s health at birth.
42. Evaluated at 1 and 5 minutes after birth.
43. Consists of 5 parameters: Appearance, Pulse, Grimace, Activity, Respiration.
44. Each parameter scored from 0 to 2 points.
45. Score 7–10 indicates normal adaptation.
46. Score 4–6 requires immediate medical attention.
47. Score 0–3 indicates severe distress, needs resuscitation.
48. Heart rate is the most critical Apgar factor.
49. Color assessment: pink is normal, blue indicates cyanosis.
50. Grimace response checks reflex irritability.

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d) Examination for Defects

51. Check for congenital heart defects using auscultation.
52. Examine palate for cleft lip or cleft palate.
53. Assess limbs for deformities like clubfoot.
54. Check spine for neural tube defects like spina bifida.
55. Observe genitalia for ambiguous development.
56. Palpate abdomen for organ enlargement.
57. Check for hip dislocation with Ortolani and Barlow tests.
58. Examine ears for shape and hearing response.
59. Look for webbed fingers/toes (syndactyly).
60. Down syndrome features include flat nasal bridge and single palmar crease.
61. Assess for microcephaly or macrocephaly.
62. Check anus for patency (imperforate anus).
63. Identify birthmarks like Mongolian spots.
64. Screen for jaundice or abnormal skin coloration.
65. Evaluate umbilical hernia or abdominal wall defects.

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e) Breastfeeding – Baby-Friendly Hospital Initiative (BFHI)

66. BFHI promotes breastfeeding-friendly hospital practices.
67. Early initiation of breastfeeding within 1 hour of birth.
68. Promote exclusive breastfeeding for the first 6 months.
69. Rooming-in to encourage mother-infant bonding.
70. Avoid pacifiers and artificial nipples.
71. Provide breastfeeding counseling to mothers.
72. No supplementation unless medically indicated.
73. Support on-demand feeding, day and night.
74. Promote breastfeeding in sick and preterm babies.
75. Educate about breastfeeding benefits for both mother and baby.
76. Encourage colostrum feeding as the first vaccine.
77. Ensure hospitals have trained staff for breastfeeding support.
78. Implement breastfeeding policies in maternity wards.
79. Discourage unnecessary use of formula milk.
80. Teach proper latching techniques for effective feeding.

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f) Care of Newborn – Skin, Eyes, Buttocks, etc.

81. Keep the newborn’s skin clean and dry.
82. Use mild soap for bathing to avoid irritation.
83. Umbilical stump care to prevent infection.
84. Apply antiseptic if recommended for cord care.
85. Keep the cord dry and exposed to air.
86. Protect buttocks from diaper rash with frequent changes.
87. Apply zinc oxide cream for diaper rash.
88. Clean genital area gently with warm water.
89. Avoid powder as it may irritate the skin.
90. Eye care includes wiping with sterile cotton if needed.
91. Prevent ophthalmia neonatorum with antibiotic eye drops.
92. Skin peeling is normal in newborns; avoid oils.
93. Use soft clothing to prevent skin irritation.
94. Avoid overheating; dress in light layers.
95. Trim nails carefully to prevent scratching.
96. Avoid strong perfumes or products on newborn skin.
97. Check for skin rashes or infections regularly.
98. Keep the baby’s skin moisturized in dry conditions.
99. Hand hygiene is crucial before handling the baby.
100. Protect from sun exposure to prevent burns.

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g) Bonding and Rooming-In

101. Bonding enhances emotional connection between parent and baby.
102. Skin-to-skin contact promotes bonding and warmth.
103. Rooming-in allows mother and baby to stay together 24/7.
104. Early bonding improves breastfeeding success.
105. Bonding reduces maternal anxiety and postpartum depression.
106. Rooming-in promotes frequent feeding.
107. Babies cry less with close parental contact.
108. Encourages parental confidence in newborn care.
109. Enhances emotional security for the newborn.
110. Supports thermoregulation through skin contact.
111. Fathers should be encouraged to bond early.
112. Responsive parenting starts with early bonding.
113. Rooming-in reduces the risk of hospital-acquired infections.
114. Encourages recognition of hunger cues.
115. Promotes early parent-infant attachment.

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h) Minor Disorders of Newborn

Birthmarks, Rashes, Skin Conditions

116. Mongolian spots are common bluish patches on the back.
117. Strawberry hemangiomas are raised red birthmarks.
118. Milia are tiny white bumps on the nose and face.
119. Erythema toxicum causes red spots with white centers—normal.
120. Port-wine stains are flat, reddish-purple birthmarks.
121. Vernix caseosa is a protective white coating at birth.
122. Peeling skin is common in post-term babies.
123. Transient neonatal pustular melanosis is benign and resolves naturally.
124. Lanugo is fine hair seen in preterm babies.
125. Café-au-lait spots may indicate neurofibromatosis if multiple.

Infections, Sore Buttocks

126. Diaper rash is caused by prolonged moisture exposure.
127. Use barrier creams to prevent diaper dermatitis.
128. Keep the diaper area clean and dry.
129. Candida diaper rash requires antifungal treatment.
130. Bacterial skin infections may present as pustules.
131. Omphalitis is an infection of the umbilical stump.
132. Seborrheic dermatitis (cradle cap) appears as flaky scalp patches.
133. Heat rash (prickly heat) occurs in hot environments.
134. Impetigo is a contagious skin infection needing antibiotics.
135. Thrush presents as white patches in the mouth.

Infections of the Eyes

136. Ophthalmia neonatorum is a serious eye infection in newborns.
137. Prevent with antibiotic eye drops after birth.
138. Conjunctivitis may be bacterial or viral.
139. Blocked tear ducts cause watery eyes—often self-resolving.
140. Eye redness without discharge may be due to irritation.
141. Clean eyes with sterile saline if discharge is present.
142. Seek medical attention for persistent swelling or redness.
143. Eye discharge with yellow pus indicates possible infection.
144. Photophobia in newborns requires urgent evaluation.
145. Eye rolling may be normal, but persistent issues need assessment.

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Bonus Quick Revision

146. Newborns should pass urine within 24 hours.
147. Meconium is the first stool, dark green-black.
148. Jaundice in the first 24 hours is pathological.
149. Breast milk is the best nutrition for infants.
150. Kangaroo mother care is beneficial for preterm babies.

Management of Normal Puerperium.

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a) Definition and Objectives of Care

1. Puerperium is the period after childbirth lasting about 6 weeks.
2. It involves the return of the reproductive organs to the pre-pregnancy state.
3. The primary objective of puerperal care is to ensure maternal recovery.
4. Monitor for complications like infection or hemorrhage.
5. Promote breastfeeding and infant care.
6. Support psychological adjustment to motherhood.
7. Encourage early ambulation to prevent thrombosis.
8. Prevent postpartum infections through hygiene.
9. Educate mothers on self-care during recovery.
10. Provide emotional support to prevent postpartum depression.

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b) Physiological Changes

11. Involution is the shrinking of the uterus back to its normal size.
12. The uterus returns to the pelvic cavity by the 10th day postpartum.
13. Lochia is postpartum vaginal discharge—progresses from red to white.
14. Lochia rubra lasts for 3–4 days, red in color.
15. Lochia serosa is pinkish, lasting from days 4–10.
16. Lochia alba is whitish, lasting from day 10 up to 6 weeks.
17. Breast engorgement occurs as milk production increases.
18. Hormonal changes involve a drop in estrogen and progesterone.
19. Ovulation can return as early as 6 weeks postpartum in non-lactating mothers.
20. Cardiac output gradually returns to normal.
21. Increased risk of thromboembolism due to hypercoagulable state.
22. Weight loss occurs due to fluid shifts and uterine involution.
23. The abdomen remains soft with decreased muscle tone.
24. Bladder capacity increases, raising the risk of retention.
25. Emotional changes include mood swings or postpartum blues.

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c) Postnatal Counselling

26. Provide education on breastfeeding techniques.
27. Counsel on signs of postpartum depression.
28. Discuss family planning options early.
29. Teach signs of danger: excessive bleeding, fever, or severe pain.
30. Encourage exclusive breastfeeding for 6 months.
31. Explain the importance of postnatal check-ups.
32. Educate on hygiene practices to prevent infections.
33. Offer support for newborn care and parenting skills.
34. Discuss return to sexual activity when comfortable.
35. Encourage nutritional counseling for recovery.
36. Provide advice on contraception even during breastfeeding.
37. Counsel on pelvic floor exercises to regain muscle strength.
38. Support for mothers experiencing grief after loss.
39. Address concerns about body image changes.
40. Promote mental health resources if needed.

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d) Lactation and Feeding

41. Lactation is the production of breast milk post-delivery.
42. Colostrum is the first milk, rich in antibodies.
43. Prolactin hormone stimulates milk production.
44. Oxytocin aids milk ejection or “let-down” reflex.
45. Frequent breastfeeding stimulates more milk production.
46. Encourage on-demand feeding day and night.
47. Avoid formula feeding unless medically indicated.
48. Proper latch prevents nipple soreness.
49. Hydration and nutrition support good milk supply.
50. Breastfeeding reduces postpartum bleeding due to oxytocin release.
51. Exclusive breastfeeding recommended for 6 months.
52. Breastfeeding reduces the risk of ovarian and breast cancer.
53. Engorgement can be relieved by frequent nursing.
54. Mastitis is an infection causing breast pain and redness.
55. Cracked nipples may indicate poor latch.
56. Blocked ducts can be managed with massage and warm compresses.
57. Breastfeeding provides passive immunity to the baby.
58. Avoid pacifiers in the early weeks to establish breastfeeding.
59. Breastfeeding-friendly environments support maternal confidence.
60. Ensure burping the baby after feeds to prevent gas.

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e) Care During Puerperium

Breast and Perineal Care

61. Keep breasts clean; no need for harsh soaps.
62. Wear a supportive bra to reduce discomfort.
63. Apply warm compresses for engorgement relief.
64. For sore nipples, use lanolin cream or expressed milk.
65. Keep the perineal area clean and dry.
66. Use sitz baths for perineal pain relief.
67. Apply ice packs for perineal swelling.
68. Practice frequent pad changes to maintain hygiene.
69. Observe for signs of perineal infection—redness, swelling, foul discharge.
70. Kegel exercises improve pelvic floor strength.

Postnatal Exercise

71. Start gentle exercises once medically cleared.
72. Pelvic floor exercises prevent urinary incontinence.
73. Walking promotes circulation and prevents blood clots.
74. Avoid strenuous exercise until fully recovered.
75. Focus on core strengthening exercises gradually.

Postnatal Examination

76. Check vital signs regularly.
77. Assess for uterine involution by palpation.
78. Examine for breast engorgement or mastitis.
79. Monitor lochia for color, amount, and odor.
80. Assess perineal healing after episiotomy or tears.
81. Screen for postpartum depression symptoms.
82. Monitor for deep vein thrombosis signs.
83. Check for bladder and bowel function.
84. Hemoglobin levels may be checked postpartum.
85. Evaluate breastfeeding effectiveness.

Follow-up

86. First postnatal check-up recommended within 6 weeks.
87. Assess physical and emotional recovery.
88. Discuss contraceptive options during follow-up.
89. Monitor for late postpartum complications.
90. Reinforce breastfeeding support.

Family Welfare

91. Provide family planning counseling.
92. Involve partners in postnatal care discussions.
93. Encourage family support for new mothers.
94. Educate on newborn care for family members.
95. Promote exclusive breastfeeding as a family responsibility.

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f) Minor Ailments and Their Management

96. Afterpains are managed with mild analgesics.
97. Constipation is relieved with fiber, fluids, and mobility.
98. Hemorrhoids treated with sitz baths and stool softeners.
99. Breast engorgement relieved by frequent breastfeeding.
100. Nipple soreness managed with proper latching techniques.
101. Urinary retention may require temporary catheterization.
102. Backache relieved by good posture and gentle exercises.
103. Perineal discomfort eased with ice packs and analgesics.
104. Leg cramps improved with stretching and hydration.
105. Night sweats are common due to hormonal changes.
106. Fatigue managed with rest and support.
107. Mood swings are normal but monitor for depression.
108. Hair loss is temporary due to hormonal shifts.
109. Mastitis treated with antibiotics and continued breastfeeding.
110. Lochia odor change may indicate infection—seek medical help.
111. Anemia corrected with iron supplementation.
112. Bladder infections treated with antibiotics if symptomatic.
113. Headaches need evaluation for postpartum hypertension.
114. Incontinence improved with pelvic floor exercises.
115. Postpartum blues are self-limiting but need support.

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g) Family Planning

116. Postpartum family planning prevents unintended pregnancies.
117. Lactational Amenorrhea Method (LAM) effective with exclusive breastfeeding.
118. Condoms are safe immediately postpartum.
119. Progestin-only pills can be started 6 weeks postpartum if breastfeeding.
120. Intrauterine devices (IUDs) can be inserted immediately postpartum.
121. Permanent methods like tubal ligation offered for completed families.
122. Implants are effective long-term contraceptives postpartum.
123. Barrier methods have no hormonal effects.
124. Emergency contraception is available if needed.
125. Discuss family planning at postnatal visits.
126. Exclusive breastfeeding provides temporary contraception.
127. Combined oral contraceptives delayed until after 6 weeks postpartum.
128. Injectable contraceptives are safe postpartum.
129. Counsel both partners on contraceptive options.
130. Spacing pregnancies reduces maternal and infant risks.
131. Fertility awareness methods are less reliable postpartum.
132. Promote informed choice in family planning decisions.
133. Male sterilization (vasectomy) is a permanent option.
134. Counseling helps address myths about contraception.
135. Family planning improves maternal and child health.
136. Breastfeeding delays ovulation but isn’t 100% reliable.
137. Encourage couples’ participation in family planning.
138. Contraceptive counseling should be part of postpartum care.
139. Postpartum IUCD is effective for long-term contraception.
140. Progestin-only methods don’t affect breast milk supply.
141. Natural methods require tracking ovulation signs.
142. Contraceptive implants last up to 3–5 years.
143. Dual protection (condoms + another method) reduces STI risk.
144. Timely counseling prevents short pregnancy intervals.
145. Barrier methods have no hormonal side effects.
146. Birth spacing of at least 2 years is recommended.
147. Family involvement supports effective contraceptive use.
148. Emergency contraception effective within 72 hours of unprotected sex.
149. Postpartum contraception reduces maternal mortality.
150. Informed consent is essential for sterilization procedures.

Management of Complications During Pregnancy.

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a) Bleeding in Pregnancy

Early and Late Bleeding

1. Early bleeding occurs before 20 weeks of pregnancy.
2. Late bleeding happens after 20 weeks of gestation.
3. Causes of early bleeding include ectopic pregnancy, miscarriage, and molar pregnancy.
4. Causes of late bleeding include placenta previa and placental abruption.
5. Painless bleeding often indicates placenta previa.
6. Painful bleeding with uterine tenderness suggests placental abruption.
7. Ultrasound (USG) is crucial for diagnosing causes of bleeding.
8. Monitor vital signs to assess maternal stability.
9. Anti-D immunoglobulin is given to Rh-negative mothers after bleeding.
10. Immediate medical attention is required for heavy bleeding.

Ectopic Pregnancy

11. Ectopic pregnancy is implantation outside the uterine cavity.
12. Most common site is the fallopian tube.
13. Symptoms include abdominal pain, vaginal bleeding, and missed period.
14. Shoulder pain may indicate internal bleeding.
15. Diagnosed using transvaginal ultrasound and β-hCG levels.
16. Methotrexate is used for medical management in stable cases.
17. Surgical intervention is required for ruptured ectopic pregnancy.
18. Risk factors: PID, prior ectopic, tubal surgery, IVF.
19. Unstable vitals require emergency surgery.
20. Follow-up with serial β-hCG levels post-treatment.

Abortion

21. Abortion is loss of pregnancy before 20 weeks gestation.
22. Threatened abortion involves bleeding with a closed cervix.
23. Inevitable abortion has an open cervix with bleeding.
24. Incomplete abortion means retained products in the uterus.
25. Complete abortion: all products of conception expelled.
26. Missed abortion: fetus has died but is retained in the uterus.
27. Septic abortion: infection after an abortion.
28. Management includes expectant, medical, or surgical evacuation.
29. Administer anti-D to Rh-negative mothers after abortion.
30. Provide emotional support and counseling.

Antepartum Hemorrhage (APH)

31. APH refers to bleeding after 20 weeks of pregnancy.
32. Common causes: placenta previa and placental abruption.
33. Placenta previa causes painless, bright red bleeding.
34. Placental abruption causes painful, dark red bleeding.
35. Use ultrasound to diagnose APH causes.
36. Avoid vaginal exams if placenta previa is suspected.
37. IV fluids and blood transfusion may be needed for severe bleeding.
38. Early delivery may be necessary in severe APH.
39. Continuous fetal monitoring is essential.
40. Cesarean section often required for placenta previa.

Vesicular Mole (Molar Pregnancy)

41. Molar pregnancy is abnormal trophoblastic growth.
42. Symptoms: vaginal bleeding, enlarged uterus, and high β-hCG.
43. Snowstorm appearance on ultrasound is diagnostic.
44. Increased risk of choriocarcinoma.
45. Treated with suction evacuation.
46. Monitor β-hCG until undetectable post-evacuation.
47. Avoid pregnancy for 6–12 months after treatment.
48. Symptoms include severe nausea and early preeclampsia.
49. Types: complete mole and partial mole.
50. Regular follow-up to detect persistent disease.

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b) Hyperemesis Gravidarum

51. Hyperemesis gravidarum is severe vomiting in pregnancy.
52. Leads to dehydration, electrolyte imbalance, and weight loss.
53. Risk factors: multiple pregnancies, molar pregnancy, first pregnancy.
54. Managed with IV fluids, antiemetics, and electrolyte correction.
55. Monitor for ketosis in severe cases.
56. Hospitalization may be necessary.
57. Complications: Wernicke’s encephalopathy if untreated.
58. Rule out other causes: UTI, gastroenteritis, thyroid disorders.
59. First-line treatment includes vitamin B6 and doxylamine.
60. Provide nutritional support when oral intake is insufficient.

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c) Gestational Diabetes Mellitus (GDM)

61. GDM is glucose intolerance first recognized during pregnancy.
62. Risk factors: obesity, family history of diabetes, previous large baby.
63. Screen with oral glucose tolerance test (OGTT) at 24–28 weeks.
64. Management starts with dietary changes and exercise.
65. Insulin is the treatment of choice if needed.
66. Poorly controlled GDM increases risk of macrosomia.
67. Increases risk of preeclampsia and preterm birth.
68. Monitor fetal growth with ultrasounds.
69. Postpartum follow-up includes testing for type 2 diabetes.
70. Encourage breastfeeding to improve glucose metabolism.

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d) Pregnancy-Induced Hypertension (PIH)

Preeclampsia

71. Preeclampsia: high BP with proteinuria after 20 weeks gestation.
72. Symptoms: headache, vision changes, swelling.
73. Risk factors: first pregnancy, obesity, multiple gestation.
74. Prevent seizures with magnesium sulfate.
75. Control BP with labetalol or nifedipine.
76. Delivery is the definitive treatment.
77. Watch for HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets.
78. Can cause fetal growth restriction (IUGR).
79. Regular BP monitoring and urine checks are crucial.
80. Severe cases may need early delivery.

Eclampsia

81. Eclampsia: preeclampsia with seizures.
82. Treat seizures with magnesium sulfate.
83. Ensure airway protection during seizures.
84. Aggressively control blood pressure.
85. Immediate delivery once stabilized.
86. Monitor for magnesium toxicity (reflexes, breathing).
87. Calcium gluconate is the antidote for magnesium toxicity.
88. Fetal distress common during seizures.
89. Rule out other causes of seizures like stroke or infection.
90. Educate on warning signs: severe headache, vision changes.

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e) Hydramnios (Polyhydramnios and Oligohydramnios)

91. Polyhydramnios: excessive amniotic fluid (>2000 mL).
92. Causes: diabetes, fetal anomalies, multiple pregnancies.
93. Symptoms: abdominal discomfort, breathlessness, preterm labor.
94. Diagnosed by amniotic fluid index (AFI) via ultrasound.
95. Amnioreduction may relieve severe symptoms.
96. Risk of preterm labor and cord prolapse.
97. Oligohydramnios: low amniotic fluid (<500 mL).
98. Causes: placental insufficiency, IUGR, ruptured membranes.
99. Monitored with serial ultrasounds.
100. Amnioinfusion can help during labor to relieve cord compression.

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f) Pelvic Inflammatory Disease (PID)

101. PID is infection of the reproductive organs, rare in pregnancy.
102. Symptoms: lower abdominal pain, fever, vaginal discharge.
103. Often caused by STIs like chlamydia and gonorrhea.
104. Diagnosed with pelvic exam, ultrasound, and cultures.
105. Treated with broad-spectrum antibiotics.
106. Hospitalization if severe or during pregnancy.
107. Complications: infertility, ectopic pregnancy, abscess.
108. Prevent with safe sex practices.
109. Educate on early treatment of infections.
110. Monitor for sepsis in severe cases.

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g) Intrauterine Growth Restriction (IUGR)

111. IUGR: fetal growth below the 10th percentile.
112. Causes: placental insufficiency, preeclampsia, malnutrition.
113. Diagnosed with ultrasound and Doppler studies.
114. Monitor with NST and biophysical profile.
115. Maternal rest and nutrition may help.
116. Delivery indicated if growth stops or fetus distressed.
117. Risk of stillbirth if untreated.
118. Symmetric IUGR: proportional growth restriction.
119. Asymmetric IUGR: head-sparing growth restriction.
120. Early detection improves outcomes.

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h) Post-maturity

121. Post-maturity: pregnancy beyond 42 weeks.
122. Risks: macrosomia, oligohydramnios, stillbirth.
123. Consider induction of labor after 41 weeks.
124. Monitor with NST and ultrasound for fetal well-being.
125. Increased risk of meconium aspiration syndrome.
126. Assess amniotic fluid levels regularly.
127. Use cervical ripening agents for induction.
128. Monitor closely during labor to avoid distress.
129. Macrosomic babies may need cesarean.
130. Educate on fetal movement counting.

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i) Intrauterine Death (IUD)

131. IUD: fetal death after 20 weeks gestation.
132. Causes: placental insufficiency, infections, genetic disorders.
133. Symptoms: absence of fetal movements.
134. Diagnosed by ultrasound showing no heartbeat.
135. Induction of labor for delivery.
136. Provide emotional support and grief counseling.
137. Investigate cause with lab tests and placental exam.
138. Risk of coagulopathy if retained too long.
139. Autopsy may help determine cause.
140. Support families with bereavement resources.

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High-Risk Pregnancy Conditions

141. NST monitors fetal heart rate and well-being.
142. Reactive NST indicates a healthy fetus.
143. Biophysical profile includes NST and ultrasound findings.
144. Anemia in pregnancy: Hb <11 g/dL.
145. Causes: iron deficiency, folate deficiency.
146. Treated with iron supplements.
147. Severe anemia may need blood transfusion.
148. Jaundice in pregnancy could indicate HELLP syndrome.
149. Viral infections like rubella can cause fetal anomalies.
150. Prevent infections with vaccination before pregnancy.

High-Risk Pregnancy Conditions.

Urinary Tract Infections (UTIs)

151. UTI is common in pregnancy due to hormonal changes.
152. Symptoms: burning sensation, frequent urination, lower abdominal pain.
153. Asymptomatic bacteriuria can lead to pyelonephritis if untreated.
154. Diagnosed with urine culture.
155. Treated with pregnancy-safe antibiotics like amoxicillin.
156. Untreated UTI increases the risk of preterm labor.
157. Encourage hydration to prevent UTIs.
158. Wipe front to back to reduce infection risk.
159. Screen for UTIs at first prenatal visit.
160. Recurrent UTIs may require prophylactic antibiotics.

Heart Diseases in Pregnancy

161. Pregnancy increases cardiac workload due to increased blood volume.
162. Risk of heart failure in women with pre-existing heart conditions.
163. Symptoms: breathlessness, palpitations, cyanosis.
164. Monitor with ECG and echocardiography.
165. Anticoagulation therapy may be needed in valvular heart disease.
166. Vaginal delivery preferred unless cardiac decompensation occurs.
167. Beta-blockers may be used safely under supervision.
168. High-risk cases require multidisciplinary care.
169. Infective endocarditis prophylaxis may be required during delivery.
170. Avoid excessive fluid overload during labor.

Diabetes in Pregnancy (Pre-existing)

171. Pre-existing diabetes increases the risk of congenital anomalies.
172. Good glycemic control reduces risks during pregnancy.
173. Insulin is the preferred treatment during pregnancy.
174. Monitor with HbA1c and blood glucose levels.
175. Risk of macrosomia, polyhydramnios, and stillbirth.
176. Frequent ultrasounds to monitor fetal growth.
177. Risk of preeclampsia is higher in diabetic pregnancies.
178. Early delivery may be considered if complications arise.
179. Postpartum insulin needs often decrease after delivery.
180. Encourage breastfeeding to improve maternal metabolism.

AIDS and STDs in Pregnancy

181. HIV-positive mothers can transmit the virus during pregnancy, delivery, or breastfeeding.
182. Antiretroviral therapy (ART) reduces mother-to-child transmission.
183. Cesarean section recommended if high viral load.
184. Avoid breastfeeding in settings where formula is safe.
185. Routine HIV screening during antenatal care.
186. STDs like syphilis increase the risk of miscarriage and stillbirth.
187. Penicillin is effective for treating syphilis during pregnancy.
188. Genital herpes may require antiviral therapy and cesarean delivery.
189. HPV can cause genital warts; monitor but avoid unnecessary interventions.
190. Chlamydia and gonorrhea increase preterm labor risk; treat with safe antibiotics.

Osteomalacia in Pregnancy

191. Osteomalacia is softening of bones due to vitamin D deficiency.
192. Symptoms: bone pain, muscle weakness, fatigue.
193. Diagnosed with low vitamin D, calcium, and phosphorus levels.
194. Risk of pelvic deformities affecting labor.
195. Treat with vitamin D and calcium supplementation.
196. Encourage sunlight exposure for natural vitamin D synthesis.
197. High-risk groups: vegan diets, limited sun exposure, malabsorption disorders.
198. Severe cases may require phosphate supplements.
199. Regular bone health monitoring is important.
200. Ensure adequate nutritional counseling for at-risk pregnant women.

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Teenage Pregnancy

201. Teenage pregnancy is associated with higher risks of complications.
202. Increased risk of anemia, preeclampsia, preterm birth.
203. Often linked with poor prenatal care and nutritional deficiencies.
204. Greater likelihood of low birth weight infants.
205. Provide comprehensive antenatal care and counseling.
206. Nutritional support is crucial for both mother and baby.
207. Higher risk of postpartum depression.
208. Educate on family planning and contraception.
209. Promote breastfeeding for better infant health outcomes.
210. Social support reduces the risk of poor maternal outcomes.

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Elderly Primigravida

211. Elderly primigravida refers to first-time mothers over 35 years old.
212. Increased risk of gestational diabetes, preeclampsia, chromosomal anomalies.
213. Higher likelihood of cesarean section.
214. Aneuploidy screening (e.g., Down syndrome) is recommended.
215. Close fetal monitoring with NST and ultrasound.
216. Risk of placenta previa and placental abruption.
217. Preconception counseling improves outcomes.
218. Encourage regular prenatal visits.
219. Genetic counseling may be beneficial.
220. Healthy lifestyle reduces risks associated with advanced maternal age.

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Multipara (Multiple Previous Pregnancies)

221. Multipara refers to women who have had two or more pregnancies.
222. Increased risk of uterine atony, postpartum hemorrhage, placenta previa.
223. Monitor for signs of preterm labor.
224. Uterine rupture risk increases with previous cesarean sections.
225. Regular fetal growth monitoring is important.
226. Higher chance of rapid labor (precipitous labor).
227. May have iron deficiency anemia due to repeated pregnancies.
228. Counsel on family planning options.
229. Ensure adequate spacing between pregnancies.
230. Pelvic floor exercises help prevent prolapse.

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Multiple Pregnancy (Twins, Triplets, etc.)

231. Multiple pregnancy increases risks for both mother and babies.
232. Higher chance of preterm birth and low birth weight.
233. Risk of twin-to-twin transfusion syndrome in monochorionic twins.
234. Frequent ultrasounds needed to monitor growth.
235. Increased maternal risk of preeclampsia and gestational diabetes.
236. Monitor for anemia due to higher iron demands.
237. Cesarean section is common in multiple pregnancies.
238. Ensure adequate nutrition and caloric intake.
239. Risk of preterm labor is significantly higher.
240. Fetal reduction may be considered in high-order multiples.

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Monitoring in High-Risk Pregnancies

Non-Stress Test (NST)

241. NST monitors fetal heart rate in response to fetal movements.
242. A reactive NST indicates good fetal health.
243. Non-reactive NST may require further evaluation.
244. Used for monitoring in diabetes, preeclampsia, and IUGR.
245. Often combined with a biophysical profile.

Ultrasound (USG)

246. USG assesses fetal growth, amniotic fluid, and placental health.
247. Doppler studies evaluate blood flow to the fetus.
248. Important for detecting congenital anomalies.
249. Serial ultrasounds track growth in IUGR cases.
250. Helps guide decisions on timing of delivery.

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Infections During Pregnancy

Anemia in Pregnancy

251. Anemia increases the risk of preterm labor and low birth weight.
252. Caused by iron deficiency, folate deficiency, or hemoglobinopathies.
253. Symptoms: fatigue, pallor, breathlessness.
254. Treated with iron supplements and dietary modifications.
255. Severe anemia may require blood transfusion.

Jaundice in Pregnancy

256. Jaundice may indicate HELLP syndrome, acute fatty liver, or hepatitis.
257. Symptoms: yellowing of eyes/skin, nausea, abdominal pain.
258. Requires liver function tests for evaluation.
259. Prompt treatment reduces risk of maternal mortality.
260. Delivery may be needed in severe cases.

Viral Infections

261. Rubella, cytomegalovirus, and parvovirus B19 can cause fetal anomalies.
262. Hepatitis B increases the risk of vertical transmission.
263. Zika virus linked to microcephaly in infants.
264. Influenza can be severe in pregnant women; vaccination recommended.
265. Screen for TORCH infections in suspected cases.

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Additional High-Risk Factors

Osteomalacia in Pregnancy

266. Osteomalacia results from vitamin D deficiency.
267. Causes bone pain, muscle weakness, and fractures.
268. Risk of pelvic deformities complicating delivery.
269. Managed with vitamin D and calcium supplementation.
270. Encourage sun exposure for vitamin D synthesis.

Teenage Pregnancy

271. High risk of anemia, preeclampsia, and preterm birth.
272. Associated with poor prenatal care and nutritional deficiencies.
273. Greater likelihood of low birth weight infants.
274. Provide comprehensive antenatal care and counseling.
275. Emphasize the importance of nutritional support.

Elderly Primigravida

276. Risk of gestational diabetes, preeclampsia, and chromosomal anomalies.
277. Requires close monitoring and genetic counseling.
278. Higher chance of cesarean delivery.
279. Ensure frequent prenatal visits and screening tests.
280. Promote healthy lifestyle and preconception care.

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Complications of Multiple Pregnancies

281. Risk of preterm birth, IUGR, and preeclampsia.
282. Monitor for twin-to-twin transfusion syndrome.
283. Frequent ultrasounds needed to monitor growth.
284. Higher risk of anemia and postpartum hemorrhage.
285. Consider early delivery if complications arise.

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Final Key Points for High-Risk Pregnancy

286. Regular antenatal visits are crucial for early detection of complications.
287. Multidisciplinary care improves outcomes in high-risk pregnancies.
288. Early intervention reduces maternal and fetal morbidity.
289. Encourage patient education on recognizing danger signs.
290. Prompt referral to higher centers if complications arise.
291. Emotional support is vital in managing high-risk pregnancies.
292. Family involvement enhances adherence to treatment plans.
293. Preconception counseling helps reduce risks.
294. Vaccinations like influenza and hepatitis B are safe during pregnancy.
295. Promote healthy nutrition and lifestyle changes.
296. Birth preparedness and complication readiness save lives.
297. Use of magnesium sulfate reduces eclampsia-related mortality.
298. Steroids are given for fetal lung maturity in preterm labor.
299. Kangaroo care improves outcomes in preterm babies.
300. Maternal health directly impacts neonatal outcomes—early care is key.

Management of High-Risk Labour.

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a) Malposition and Malpresentations

1. Malposition refers to abnormal positioning of the fetal head during labor.
2. Occiput posterior (OP) is the most common malposition.
3. Symptoms of OP include severe back pain during labor.
4. Manual rotation can correct fetal malposition.
5. Malpresentation means any fetal presentation other than vertex.
6. Common malpresentations: breech, face, brow, and shoulder.
7. Breech presentation occurs when the fetus’s buttocks are presenting.
8. Types of breech: frank, complete, and footling.
9. External cephalic version (ECV) can turn breech babies to head-first.
10. Cesarean section (C-section) is recommended for complicated malpresentations.
11. Face presentation involves the fetus’s face being the presenting part.
12. Brow presentation is unstable and often converts to face or vertex.
13. Shoulder presentation often leads to transverse lie.
14. Cord prolapse is more common in malpresentations.
15. Obstructed labor risk increases with abnormal presentations.

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b) Contracted Pelvis

16. Contracted pelvis is when the pelvic dimensions are too small for normal delivery.
17. Causes include rickets, pelvic fractures, and congenital abnormalities.
18. Clinical pelvimetry helps diagnose contracted pelvis.
19. Trial of labor can be attempted in mild cases.
20. C-section is preferred in severe pelvic contraction.
21. Cephalopelvic disproportion (CPD) occurs when the fetal head is too large.
22. Risk of prolonged labor and obstructed labor with contracted pelvis.
23. Pelvic inlet contraction affects the engagement of the fetal head.
24. Pelvic outlet contraction affects fetal descent during labor.
25. Molding of the fetal head may occur to compensate for a small pelvis.

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c) Abnormal Uterine Actions

26. Abnormal uterine actions disrupt the normal labor process.
27. Hypotonic uterine dysfunction involves weak contractions.
28. Managed with oxytocin augmentation to strengthen contractions.
29. Hypertonic uterine dysfunction causes strong, painful, ineffective contractions.
30. Treated with sedation and tocolytics to relax the uterus.
31. Incoordinate uterine action leads to poor labor progress.
32. Bandl’s ring indicates obstructed labor due to abnormal contractions.
33. Tachysystole: more than 5 contractions in 10 minutes.
34. Risk of fetal distress with hypertonic uterine contractions.
35. Proper hydration and pain management improve uterine function.

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d) Cervical Dystocia

36. Cervical dystocia is the failure of the cervix to dilate during labor.
37. Causes include rigid cervix, scarring, or inadequate contractions.
38. Symptoms: prolonged labor with no cervical change.
39. Managed with oxytocin to improve contractions.
40. Cesarean delivery if cervical dystocia persists.
41. Risk factors: previous cervical surgery, infection, fibrosis.
42. Associated with maternal exhaustion and fetal distress.
43. Manual dilation may be attempted cautiously.
44. Epidural analgesia can sometimes relieve dystocia.
45. Continuous monitoring is required to prevent complications.

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e) Premature Rupture of Membranes (PROM), Precipitate, and Prolonged Labor

Premature Rupture of Membranes (PROM)

46. PROM is the rupture of membranes before the onset of labor.
47. Preterm PROM (PPROM) occurs before 37 weeks.
48. Risk of infection like chorioamnionitis with prolonged PROM.
49. Confirm with speculum exam and nitrazine test.
50. Antibiotics reduce the risk of infection.
51. Corticosteroids promote fetal lung maturity in PPROM.
52. Avoid digital vaginal exams to reduce infection risk.
53. Induction of labor if infection is present.
54. Tocolytics may delay labor in PPROM without infection.
55. Monitor for signs of maternal and fetal infection.

Precipitate Labor

56. Precipitate labor is rapid labor lasting less than 3 hours.
57. Risk of perineal tears, postpartum hemorrhage, and fetal distress.
58. Managed with controlled delivery techniques.
59. Provide emotional support due to the sudden nature of delivery.
60. Monitor for uterine atony postpartum.

Prolonged Labor

61. Prolonged labor lasts more than 20 hours in primigravida and 14 hours in multipara.
62. Causes include malpresentation, CPD, and weak contractions.
63. Risk of maternal exhaustion and fetal distress.
64. Monitor labor with a partograph.
65. Augmentation with oxytocin can improve contractions.
66. Cesarean section if labor does not progress.
67. Assess for obstructed labor as a cause.
68. Provide pain relief and hydration during prolonged labor.
69. Monitor for signs of infection if labor is prolonged.
70. Early intervention reduces risks to mother and baby.

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f) Obstetric Emergencies

Cord Prolapse and Cord Presentation

71. Cord prolapse is when the umbilical cord slips ahead of the presenting part.
72. Risk factors: breech presentation, polyhydramnios, prematurity.
73. Leads to fetal hypoxia due to cord compression.
74. Emergency C-section is the preferred treatment.
75. Knee-chest position helps relieve cord compression temporarily.
76. Avoid handling the cord to prevent vasospasm.
77. Cord presentation is when the cord lies between the fetus and cervix without prolapse.
78. Continuous fetal monitoring is essential.
79. Amnioinfusion can relieve cord compression in some cases.
80. Rapid delivery is required if fetal distress occurs.

Amniotic Fluid Embolism (AFE)

81. AFE is a rare but fatal condition caused by amniotic fluid entering the maternal circulation.
82. Symptoms: sudden collapse, breathing difficulty, cardiac arrest.
83. Leads to DIC (disseminated intravascular coagulation).
84. Immediate resuscitation with CPR and oxygen.
85. Requires ICU care and multidisciplinary management.

Obstetric Shock

86. Obstetric shock can result from hemorrhage, sepsis, or AFE.
87. Symptoms: hypotension, rapid pulse, cold clammy skin.
88. IV fluids and blood transfusion are critical.
89. Identify and treat the underlying cause.
90. Monitor urine output as an indicator of perfusion.

Rupture of the Uterus

91. Uterine rupture is a tear in the uterine wall, often during labor.
92. Risk factors: previous C-section, obstructed labor, oxytocin misuse.
93. Symptoms: sudden abdominal pain, loss of fetal station, fetal distress.
94. Requires emergency laparotomy and delivery.
95. Hysterectomy may be needed if repair is not possible.

Shoulder Dystocia

96. Shoulder dystocia occurs when the fetal shoulder gets stuck after the head is delivered.
97. Risk factors: macrosomia, diabetes, obesity.
98. McRoberts maneuver and suprapubic pressure help relieve dystocia.
99. Avoid excessive pulling to prevent brachial plexus injury.
100. Zavanelli maneuver may be needed as a last resort.

Vasa Previa

101. Vasa previa is when fetal blood vessels cross the cervix unprotected.
102. Risk of fetal exsanguination if vessels rupture.
103. Presents with painless bleeding and fetal distress.
104. Diagnosed with Doppler ultrasound.
105. Emergency C-section is the treatment of choice.

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g) Complications of the Third Stage of Labor

Postpartum Hemorrhage (PPH)

106. PPH is defined as blood loss >500 mL after vaginal delivery.
107. Causes: atonic uterus, retained placenta, trauma, coagulopathy.
108. Uterine massage helps control atonic PPH.
109. Use uterotonics like oxytocin to manage bleeding.
110. Severe cases may require surgical intervention.

Atonic Uterus

111. Atonic uterus fails to contract after delivery, leading to PPH.
112. Risk factors: prolonged labor, overdistended uterus, multiparity.
113. Managed with uterotonics, bimanual compression, and fluids.
114. Balloon tamponade may help control bleeding.
115. Hysterectomy as a last resort if bleeding persists.

Injuries to the Birth Canal

116. Includes perineal tears, vaginal lacerations, cervical tears.
117. Suturing is done under proper anesthesia.
118. Risk of infection if not properly repaired.
119. Anal sphincter injuries require specialist repair.
120. Proper lighting and assessment reduce missed injuries.

Retained Placenta and Membranes

121. Retained placenta occurs if not expelled within 30 minutes post-delivery.
122. Risk of PPH and infection.
123. Managed with manual removal under anesthesia.
124. Oxytocin helps in placental expulsion.
125. Ultrasound can confirm retained products.

Inversion of the Uterus

126. Uterine inversion is when the uterus turns inside out after delivery.
127. Presents with shock and severe bleeding.
128. Managed by manual repositioning of the uterus.
129. Uterotonics are given after repositioning to maintain contraction.
130. Emergency surgery if manual repositioning fails.

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Key Final Points

131. Early recognition of complications saves lives.
132. Partograph helps detect abnormal labor progress.
133. Active management of the third stage prevents PPH.
134. Skilled birth attendants reduce maternal mortality.
135. Emergency obstetric care availability improves outcomes.
136. Multidisciplinary teams are vital in obstetric emergencies.
137. Antenatal risk assessment predicts complications.
138. Prompt referral reduces maternal and neonatal deaths.
139. Regular training drills improve emergency response.
140. Patient education on danger signs is crucial.
141. Adequate hydration prevents uterine inertia.
142. Timely C-section can be life-saving in emergencies.
143. Proper use of oxytocin prevents uterine rupture.
144. Blood transfusion services are critical for PPH management.
145. Respectful maternity care reduces trauma and improves outcomes.
146. Postpartum monitoring detects late complications.
147. Antibiotic prophylaxis reduces infection risk after procedures.
148. Emotional support is essential for women with traumatic births.
149. Documentation of all interventions ensures quality care.
150. Continued education of healthcare providers reduces maternal morbidity.

Management of Complications of Puerperium.

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1. Puerperal Pyrexia

1. Puerperal pyrexia is a fever of ≥38°C within the first 10 days postpartum.
2. The most common cause is puerperal sepsis.
3. Other causes include UTIs, mastitis, thrombophlebitis, and malaria.
4. Endometritis is the leading cause of puerperal pyrexia.
5. Fever associated with foul-smelling lochia suggests infection.
6. Broad-spectrum antibiotics are the mainstay of treatment.
7. Early identification reduces the risk of sepsis.
8. Complete blood count (CBC) helps identify infection.
9. Urine culture rules out urinary tract infections.
10. If fever persists, evaluate for retained products of conception.
11. Ultrasound helps detect retained placental fragments.
12. Good perineal hygiene reduces the risk of infections.
13. Cesarean section increases the risk of puerperal pyrexia.
14. Deep breathing exercises help prevent pulmonary infections.
15. Early ambulation reduces the risk of thrombosis-related fever.

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2. Puerperal Sepsis

16. Puerperal sepsis is infection of the genital tract occurring postpartum.
17. Caused by bacteria like Streptococcus, E. coli, and Staphylococcus.
18. Risk factors: prolonged labor, premature rupture of membranes, poor hygiene.
19. Symptoms: fever, abdominal pain, foul-smelling discharge.
20. Severe cases may progress to septic shock.
21. Start broad-spectrum antibiotics immediately.
22. Fluid resuscitation is essential in septic shock.
23. Monitor for signs of organ failure.
24. Oxygen therapy improves tissue perfusion in sepsis.
25. Blood cultures help identify causative organisms.
26. Source control includes removing infected tissues if necessary.
27. High white blood cell count suggests infection.
28. C-reactive protein (CRP) is a marker of inflammation.
29. Hysterectomy may be needed in unresponsive cases.
30. Early diagnosis reduces the risk of maternal mortality.

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3. Thrombophlebitis and Embolism

31. Thrombophlebitis is inflammation of a vein due to a blood clot.
32. Common in deep veins of the legs (DVT) postpartum.
33. Risk factors: prolonged immobilization, C-section, obesity, thrombophilia.
34. Symptoms: leg pain, swelling, redness, and tenderness.
35. Homan’s sign may indicate DVT (calf pain on dorsiflexion).
36. Confirm diagnosis with Doppler ultrasound.
37. Treat with anticoagulants like low-molecular-weight heparin.
38. Avoid massaging the affected area to prevent embolism.
39. Pulmonary embolism occurs if the clot travels to the lungs.
40. Symptoms of PE: sudden chest pain, breathlessness, hemoptysis.
41. CT pulmonary angiography helps diagnose PE.
42. Immediate oxygen therapy for suspected embolism.
43. Heparin is the first-line treatment for PE.
44. Prevent with early ambulation postpartum.
45. Compression stockings reduce the risk of DVT.
46. Elevate the legs to improve venous return.
47. Monitor for signs of bleeding during anticoagulant therapy.
48. Thrombophilia screening in recurrent cases.
49. Warfarin may be used postpartum under medical supervision.
50. Physical activity reduces the risk of thromboembolism.

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4. Breast Engorgement, Mastitis, and Breast Abscess

Breast Engorgement

51. Breast engorgement occurs due to milk accumulation.
52. Symptoms: swollen, painful, tense breasts.
53. Encourage frequent breastfeeding to relieve engorgement.
54. Apply warm compresses before feeding to ease milk flow.
55. Apply cold compresses after feeding to reduce swelling.
56. Wear a supportive bra for comfort.
57. Express breast milk if the baby is unable to feed properly.
58. Avoid sudden cessation of breastfeeding to prevent engorgement.
59. Gentle breast massage improves milk drainage.
60. Maintain adequate hydration.

Mastitis

61. Mastitis is inflammation of breast tissue, often due to infection.
62. Commonly caused by Staphylococcus aureus.
63. Symptoms: breast pain, redness, swelling, fever.
64. Continue breastfeeding from the affected breast.
65. Treat with antibiotics like dicloxacillin or cephalexin.
66. Warm compresses help relieve discomfort.
67. Proper latching techniques reduce the risk of mastitis.
68. Cracked nipples are a risk factor for mastitis.
69. Breastfeeding frequently prevents milk stasis.
70. Analgesics help manage pain and fever.

Breast Abscess

71. Breast abscess is a localized collection of pus in the breast.
72. Often a complication of untreated mastitis.
73. Symptoms: severe breast pain, swelling, fever, and fluctuant mass.
74. Confirm diagnosis with breast ultrasound.
75. Treatment includes antibiotics and surgical drainage.
76. Needle aspiration may be an option for small abscesses.
77. Continue breastfeeding from the unaffected breast.
78. Monitor for signs of sepsis.
79. Maintain good breast hygiene.
80. Lactation support helps prevent recurrence.

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5. Puerperal Psychosis

81. Puerperal psychosis is a severe mental health condition after childbirth.
82. Onset is usually within 2 weeks postpartum.
83. Symptoms: delusions, hallucinations, confusion, mood swings.
84. Associated with bipolar disorder or previous psychiatric illness.
85. Considered a psychiatric emergency requiring immediate attention.
86. Risk of self-harm or harm to the baby.
87. Requires hospitalization for safety and treatment.
88. Treatment includes antipsychotics, mood stabilizers, and psychotherapy.
89. Electroconvulsive therapy (ECT) may be effective in severe cases.
90. Family support is crucial in recovery.
91. Sleep deprivation can worsen symptoms.
92. Screen for postpartum depression and anxiety during follow-ups.
93. Early intervention improves outcomes.
94. Breastfeeding decisions depend on medication safety.
95. Monitor for recurrence in future pregnancies.
96. Risk factors: family history of psychosis, first pregnancy, stress.
97. Provide mental health education to new mothers.
98. Peer support groups help with long-term recovery.
99. Postnatal checkups should include mental health screening.
100. Suicidal thoughts require immediate psychiatric evaluation.

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Key Preventive and Management Strategies

101. Hand hygiene reduces infection risks in the puerperium.
102. Encourage early ambulation to prevent thromboembolism.
103. Promote exclusive breastfeeding for maternal and infant health.
104. Ensure adequate hydration and nutrition postpartum.
105. Perineal care reduces the risk of wound infections.
106. Proper wound care after C-section prevents sepsis.
107. Regular monitoring of vital signs helps detect early complications.
108. Prompt antibiotic therapy for infections improves outcomes.
109. Encourage mental health support postpartum.
110. Provide contraceptive counseling during postnatal visits.
111. Iron supplements help prevent postpartum anemia.
112. Monitor for signs of postpartum hemorrhage (PPH).
113. Safe sex practices prevent postpartum infections.
114. Educate on recognizing danger signs: heavy bleeding, fever, severe pain.
115. Immunizations (e.g., Tdap) protect both mother and baby.
116. Support groups help mothers cope with postpartum stress.
117. Regular follow-up visits are crucial in the postpartum period.
118. Pain management improves maternal well-being.
119. Family involvement supports maternal recovery.
120. Promote open communication about postpartum concerns.

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Complications Monitoring and Emergency Response

121. Recognize signs of postpartum hemorrhage early.
122. Rapid response to postpartum emergencies saves lives.
123. Emergency kits should be available in maternity wards.
124. Train healthcare workers in basic life support (BLS).
125. Blood transfusion services are critical in PPH management.
126. Regular drills prepare teams for obstetric emergencies.
127. Use of uterotonics helps manage uterine atony.
128. IV fluids and oxygen support stabilize critical patients.
129. Monitor for hypovolemic shock after heavy bleeding.
130. Ensure availability of emergency medications postpartum.
131. Quick referral to higher centers reduces maternal mortality.
132. Monitor urine output as an indicator of perfusion.
133. Teamwork is key in managing postpartum complications.
134. Provide counseling after traumatic birth experiences.
135. Documentation of postpartum care ensures quality.
136. Regular audits improve maternity care standards.
137. Pain management protocols improve postpartum recovery.
138. Educate about breastfeeding complications and management.
139. Monitor for signs of deep vein thrombosis postpartum.
140. Comprehensive postnatal care reduces maternal morbidity.

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Final Key Points

141. Puerperium is a critical period requiring close monitoring.
142. Early identification of complications saves lives.
143. Promote holistic care: physical, mental, and emotional well-being.
144. Encourage open discussions about postpartum mental health.
145. Provide continuous support to new mothers.
146. Antenatal education reduces postpartum risks.
147. Partner involvement supports maternal recovery.
148. Timely referral for specialized care improves outcomes.
149. Community health workers play a key role in postpartum care.
150. Focus on preventive care to reduce postpartum complications.

High-Risk and Sick Newborn.

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a) Assessment of High-Risk and Sick Newborn

1. Assessment is the first step in identifying high-risk newborns.
2. Use the APGAR score to assess newborn adaptation at 1 and 5 minutes.
3. Normal APGAR score ranges from 7–10.
4. Low APGAR score indicates the need for immediate resuscitation.
5. Assess respiratory rate; normal is 40–60 breaths per minute.
6. Heart rate should be 120–160 beats per minute in newborns.
7. Check for signs of respiratory distress: grunting, nasal flaring, retractions.
8. Evaluate skin color: cyanosis indicates hypoxia.
9. Measure temperature to detect hypothermia or fever.
10. Assess feeding ability as poor feeding can indicate illness.
11. Monitor muscle tone—hypotonia may indicate neurological issues.
12. Capillary refill time (CRT) >3 seconds suggests poor perfusion.
13. Check for jaundice within the first 24 hours; may indicate pathology.
14. Blood glucose levels assess for hypoglycemia.
15. Observe for seizures—abnormal in neonates.
16. Birth weight classification helps identify low birth weight (LBW) babies.
17. Gestational age assessment helps identify preterm or small-for-date babies.
18. Look for congenital anomalies during physical examination.
19. Monitor urine output; less than 1 mL/kg/hr suggests dehydration.
20. Observe for umbilical stump infection—redness, discharge, foul smell.

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b) Nursing Care of High-Risk Newborns

21. Maintain thermoregulation to prevent hypothermia.
22. Use skin-to-skin contact (Kangaroo Mother Care) for warmth.
23. Provide adequate nutrition—breast milk is preferred.
24. Ensure airway patency and provide oxygen if needed.
25. Monitor vital signs regularly: temperature, heart rate, respiration.
26. Practice infection control with strict hand hygiene.
27. Use aseptic techniques during procedures.
28. Administer medications as prescribed (antibiotics, vitamins).
29. Provide IV fluids carefully to prevent fluid overload.
30. Monitor for signs of sepsis: lethargy, poor feeding, temperature instability.
31. Support breastfeeding—encourage frequent feeding.
32. For non-breastfeeding babies, provide expressed breast milk.
33. Phototherapy for jaundice—monitor bilirubin levels.
34. Observe for phototherapy side effects: dehydration, rash.
35. Use pulse oximetry to monitor oxygen saturation.
36. Provide pain relief for procedures (e.g., oral sucrose).
37. Educate parents on newborn care and signs of illness.
38. Family-centered care promotes bonding and involvement.
39. Maintain fluid balance—monitor input/output.
40. Provide developmental care to support growth in NICU.

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c) Management of Specific Conditions

Hyperbilirubinemia

41. Hyperbilirubinemia is excess bilirubin causing jaundice.
42. Physiological jaundice appears after 24 hours of birth.
43. Pathological jaundice occurs within 24 hours—needs urgent attention.
44. Phototherapy is the main treatment for neonatal jaundice.
45. Severe cases may need exchange transfusion.
46. Monitor bilirubin levels regularly.
47. Ensure adequate hydration to support bilirubin excretion.
48. Breastfeeding promotes bilirubin clearance.
49. Kernicterus is brain damage due to high bilirubin.
50. Rh incompatibility increases jaundice risk.

Neonatal Hypoglycemia

51. Hypoglycemia is blood sugar <40 mg/dL in neonates.
52. Symptoms: jitteriness, poor feeding, lethargy, seizures.
53. Confirm with blood glucose testing.
54. Early feeding prevents hypoglycemia.
55. IV dextrose for severe cases.
56. Monitor blood sugar frequently in high-risk babies.
57. Babies of diabetic mothers are prone to hypoglycemia.
58. Delayed feeding increases hypoglycemia risk.
59. Provide early skin-to-skin contact to regulate glucose.
60. Breastfeeding should start within 1 hour of birth.

Hypothermia

61. Hypothermia is body temperature <36.5°C in newborns.
62. Symptoms: cold skin, weak cry, poor feeding, lethargy.
63. Prevent with warm environment and Kangaroo Mother Care.
64. Use radiant warmers for severe hypothermia.
65. Check temperature regularly.
66. Dry the baby immediately after birth to prevent heat loss.
67. Avoid cold stress by proper clothing and room temperature.
68. Rewarm gradually to avoid complications.
69. Preterm infants are at higher risk of hypothermia.
70. Ensure skin-to-skin contact to maintain body heat.

Neonatal Convulsions

71. Seizures in neonates are often subtle: eye deviation, lip smacking.
72. Causes: hypoglycemia, hypoxia, infections, metabolic issues.
73. Confirm with EEG if needed.
74. Correct underlying causes like low glucose or electrolyte imbalance.
75. Phenobarbital is the first-line anticonvulsant.
76. Monitor for respiratory depression after medication.
77. Sepsis is a common cause of neonatal seizures.
78. Ensure airway, breathing, circulation (ABC) during seizures.
79. Keep baby in a safe position during convulsions.
80. Educate parents about seizure signs.

Rh Incompatibility

81. Rh incompatibility occurs when Rh-negative mother carries an Rh-positive baby.
82. Leads to hemolytic disease of the newborn.
83. Causes jaundice, anemia, hydrops fetalis.
84. Anti-D immunoglobulin prevents sensitization.
85. Monitor bilirubin levels and treat with phototherapy.
86. Severe cases may need exchange transfusion.
87. Check Coombs test to confirm diagnosis.
88. Prenatal screening helps prevent complications.
89. Fetal monitoring for anemia during pregnancy.
90. Kernicterus risk increases without treatment.

Small for Dates (SGA)

91. SGA babies have birth weight <10th percentile for gestational age.
92. Causes: placental insufficiency, maternal hypertension, infections.
93. Risk of hypoglycemia, hypothermia, polycythemia.
94. Ensure adequate feeding to prevent hypoglycemia.
95. Monitor growth parameters regularly.
96. Thermal protection is critical.
97. Risk of neurodevelopmental delay.
98. Provide early intervention services if needed.
99. Monitor for respiratory distress.
100. Promote breastfeeding for optimal nutrition.

Low Birth Weight (LBW)

101. LBW is <2,500 grams at birth.
102. Risk factors: prematurity, IUGR, multiple pregnancies.
103. Higher risk of infection, hypoglycemia, hypothermia.
104. Kangaroo Mother Care improves outcomes.
105. Provide frequent feeding for growth.
106. Monitor for jaundice and dehydration.
107. Immunization as per schedule without delay.
108. Prevent cold stress with proper wrapping.
109. Regular growth monitoring is essential.
110. Support for breastfeeding to ensure adequate nutrition.

Preterm Newborn

111. Preterm is birth before 37 weeks of gestation.
112. Risk of respiratory distress syndrome (RDS).
113. Surfactant therapy improves lung function.
114. Antenatal steroids promote lung maturity.
115. Thermoregulation is critical in preterms.
116. Risk of necrotizing enterocolitis (NEC)—monitor feeding.
117. Provide parenteral nutrition if oral feeds not tolerated.
118. Risk of intraventricular hemorrhage (IVH).
119. Use gentle handling to reduce stress.
120. Follow-up care for developmental delays.

Asphyxia and Respiratory Distress Syndrome (RDS)

121. Birth asphyxia is lack of oxygen during birth.
122. Leads to hypoxic-ischemic encephalopathy (HIE).
123. Neonatal resuscitation is lifesaving in asphyxia.
124. Use positive pressure ventilation (PPV) if baby not breathing.
125. RDS is due to surfactant deficiency in preterms.
126. Symptoms: grunting, retractions, cyanosis.
127. Treat with CPAP and surfactant replacement.
128. Monitor oxygen saturation closely.
129. Antenatal steroids prevent RDS in preterms.
130. Ensure thermoregulation to reduce oxygen needs.

Neonatal Sepsis

131. Neonatal sepsis is a life-threatening infection in newborns.
132. Symptoms: poor feeding, lethargy, temperature instability.
133. Early-onset sepsis occurs within 72 hours of birth.
134. Risk factors: PROM, maternal infection, prematurity.
135. Blood cultures confirm diagnosis.
136. Treat with IV antibiotics immediately.
137. Supportive care with fluids and oxygen.
138. Monitor for organ dysfunction.
139. Hand hygiene reduces infection transmission.
140. Sepsis screen includes CRP, WBC count, and cultures.

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d) Newborn of HIV-Positive and Diabetic Mother

HIV-Positive Mother

141. Risk of mother-to-child transmission of HIV.
142. Antiretroviral therapy (ART) reduces transmission risk.
143. Avoid breastfeeding if formula is safe and accessible.
144. Neonatal ART prophylaxis is essential.
145. Test baby for HIV at 6 weeks using PCR.
146. Monitor for signs of immunodeficiency.
147. Provide routine vaccinations except live vaccines if immunocompromised.
148. Early diagnosis improves outcomes.
149. Promote safe delivery practices to reduce transmission.
150. Counsel parents about HIV care for the baby.

Diabetic Mother

151. Babies of diabetic mothers are at risk of hypoglycemia.
152. Symptoms: jitteriness, lethargy, poor feeding.
153. Early breastfeeding reduces hypoglycemia risk.
154. Monitor blood glucose levels regularly.
155. Risk of macrosomia and birth injuries.
156. Polycythemia and jaundice are common complications.
157. Risk of congenital heart defects.
158. Perform echocardiogram if needed.
159. Monitor for respiratory distress syndrome (RDS).
160. Provide thermoregulation to prevent cold stress.

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e) Levels of Care in NICU

161. Level I: Basic newborn care for healthy infants.
162. Includes routine resuscitation, thermoregulation, and feeding support.
163. Level II: Intermediate care for moderately ill newborns.
164. Provides oxygen therapy, IV fluids, and phototherapy.
165. Manages moderate preterm babies (32–37 weeks).
166. Level III NICU: Intensive care for critically ill newborns.
167. Offers mechanical ventilation and surfactant therapy.
168. Manages very low birth weight (VLBW) babies (<1500g).
169. Includes central line care and parenteral nutrition.
170. Level IV NICU: Advanced care with surgical facilities.
171. Provides care for congenital anomalies needing surgery.
172. Has pediatric subspecialists available 24/7.
173. Offers ECMO for severe respiratory failure.
174. Transport facilities for transferring critical babies.
175. Focus on family-centered care in all NICU levels.
176. Neonatal resuscitation programs (NRP) improve outcomes.
177. Skilled staff is essential for NICU care.
178. Regular training and updates for NICU personnel.
179. Promote kangaroo care even in NICU settings.
180. Developmental supportive care enhances neurodevelopment.
181. Infection control practices reduce NICU infections.
182. Parental involvement improves bonding and outcomes.
183. Breast milk is preferred even for NICU babies.
184. Discharge planning includes follow-up schedules.
185. Early intervention services for high-risk NICU graduates.
186. Monitor growth and neurodevelopment post-discharge.
187. Provide psychological support to NICU parents.
188. Focus on preventive care to reduce NICU admissions.
189. Telemedicine supports neonatal care in remote areas.
190. Standard protocols improve NICU quality care.
191. Resuscitation equipment should be readily available.
192. Continuous monitoring is key in NICU.
193. Regular audits to improve NICU performance.
194. Emergency drugs should be accessible in NICU.
195. Promote breastfeeding even in preterm and sick babies.
196. Family support groups help parents of NICU babies.
197. Pain management is important even for neonates.
198. Hypothermia prevention during transport is critical.
199. Follow-up clinics for high-risk infants post-NICU.
200. Focus on holistic care for high-risk and sick newborns.

Obstetric Operations

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a) Definition, Indication, and Care of Women Undergoing Obstetric Procedures

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Induction of Labour

1. Induction of labour is the artificial initiation of uterine contractions.
2. Indications: post-term pregnancy, preeclampsia, fetal growth restriction.
3. Contraindications: placenta previa, transverse lie, previous uterine rupture.
4. Common methods: oxytocin infusion, prostaglandins, and mechanical methods.
5. Bishop score assesses cervical readiness for induction.
6. A Bishop score ≥6 indicates a favorable cervix.
7. Monitor fetal heart rate during induction.
8. Risk of uterine hyperstimulation with oxytocin.
9. Provide pain management during labor induction.
10. Continuous monitoring reduces the risk of fetal distress.

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Manual Removal of Placenta

11. Manual removal of placenta involves separating and extracting the placenta manually.
12. Indications: retained placenta after delivery (>30 minutes), severe bleeding.
13. Requires anesthesia or sedation for pain control.
14. Perform under aseptic conditions to prevent infection.
15. Monitor for postpartum hemorrhage after the procedure.
16. Administer uterotonics to promote uterine contraction.
17. Risk of uterine inversion if traction is excessive.
18. Observe for signs of infection post-procedure.
19. Check for complete removal of placental tissue.
20. Provide antibiotic prophylaxis to prevent sepsis.

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Version

21. Version is the manipulation of the fetus to change its position.
22. External cephalic version (ECV) is done to turn breech to cephalic presentation.
23. Indications: breech presentation after 36 weeks.
24. Contraindications: placenta previa, multiple pregnancy, oligohydramnios.
25. Performed under ultrasound guidance.
26. Monitor fetal heart rate before and after the procedure.
27. Administer tocolytics to relax the uterus if needed.
28. Risk of fetal distress, placental abruption, or cord entanglement.
29. Emergency C-section may be needed if complications occur.
30. Educate the mother about procedure risks and benefits.

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Forceps Delivery

31. Forceps delivery assists vaginal delivery using forceps.
32. Indications: prolonged second stage, fetal distress, maternal exhaustion.
33. Types: outlet, low, mid-forceps delivery.
34. Requires full cervical dilation and engaged fetal head.
35. Complications: vaginal tears, facial nerve injury, cephalohematoma.
36. Performed under local or regional anesthesia.
37. Ensure bladder is empty before procedure.
38. Apply forceps with care to avoid fetal head injury.
39. Monitor for postpartum hemorrhage post-delivery.
40. Provide perineal care after the procedure.

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Vacuum Extraction

41. Vacuum extraction uses suction to assist vaginal delivery.
42. Indications: prolonged second stage, fetal distress, maternal fatigue.
43. Contraindications: preterm infants, breech presentation, fetal bleeding disorders.
44. Ensure cervix is fully dilated and fetal head is engaged.
45. Complications: scalp lacerations, cephalohematoma, subgaleal hemorrhage.
46. Limit traction attempts to three pulls to avoid injury.
47. Apply suction cup at the flexion point on the fetal head.
48. Monitor fetal heart rate during the procedure.
49. Avoid prolonged traction to prevent fetal brain injury.
50. Educate the mother about possible complications.

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Caesarean Section (C-Section)

51. C-section is the surgical delivery of a baby through the abdominal wall.
52. Indications: fetal distress, CPD, placenta previa, breech presentation.
53. Types: lower segment and classical C-section.
54. Requires regional (spinal/epidural) or general anesthesia.
55. Risk of infection, hemorrhage, thromboembolism.
56. Preoperative care: consent, IV access, bladder catheterization.
57. Administer prophylactic antibiotics before incision.
58. Monitor vital signs and fetal heart rate intraoperatively.
59. Postoperative care includes pain management, early ambulation, and wound care.
60. VBAC (Vaginal Birth After C-section) is possible in selected cases.

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Sterilization

61. Sterilization is a permanent method of contraception.
62. Tubal ligation is common for female sterilization.
63. Indications: desired permanent contraception.
64. Can be done during C-section or postpartum period.
65. Methods: laparoscopic or minilaparotomy.
66. Risks: bleeding, infection, failure leading to pregnancy.
67. Provide thorough counseling about irreversibility.
68. No effect on hormonal balance or menstrual cycle.
69. Consent is mandatory before the procedure.
70. Postoperative care includes monitoring for infection.

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Destructive Surgeries

71. Destructive surgeries are done for obstructed labor with dead fetus.
72. Types: craniotomy, decapitation, cleidotomy.
73. Indicated when C-section is not feasible in resource-limited settings.
74. Performed under anesthesia with aseptic precautions.
75. High risk of maternal injury and infection.
76. Requires experienced operator for safe procedure.
77. Monitor for uterine rupture post-procedure.
78. Provide psychological support to the mother.
79. Antibiotics to prevent sepsis post-surgery.
80. Family counseling is important after the procedure.

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Amnioinfusion

81. Amnioinfusion is the infusion of fluid into the amniotic sac.
82. Indications: variable decelerations, oligohydramnios, thick meconium-stained liquor.
83. Performed via an intrauterine catheter during labor.
84. Reduces cord compression and improves fetal oxygenation.
85. Monitor for uterine overdistension and infection.
86. Contraindications: uterine hyperstimulation, chorioamnionitis.
87. Requires continuous fetal heart monitoring.
88. Use sterile saline or Ringer’s lactate.
89. Observe for signs of uterine rupture.
90. Fluid output from the vagina should be monitored.

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Manual Vacuum Aspiration (MVA)

91. MVA is used for early pregnancy termination or incomplete abortion.
92. Safe up to 12 weeks of gestation.
93. Less invasive than dilation and curettage (D&C).
94. Requires local anesthesia and aseptic technique.
95. Complications: infection, uterine perforation, incomplete evacuation.
96. Post-procedure care includes antibiotics and pain relief.
97. Confirm complete evacuation with ultrasound if needed.
98. Educate about contraception post-procedure.
99. Monitor for heavy bleeding post-MVA.
100. Provide emotional support after the procedure.

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Dilation and Evacuation (D&E)

101. D&E is performed for second-trimester abortions.
102. Involves dilation of the cervix followed by evacuation of uterine contents.
103. Requires anesthesia and strict aseptic technique.
104. Risk of uterine perforation, infection, hemorrhage.
105. Monitor for vital signs post-procedure.
106. Ultrasound guidance improves safety.
107. Provide analgesics for post-procedure cramping.
108. Ensure contraceptive counseling post-D&E.
109. Observe for signs of retained products of conception.
110. Provide psychological counseling if needed.

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Dilation and Curettage (D&C)

111. D&C is scraping of the uterine lining to remove contents.
112. Used for incomplete abortion, missed abortion, or diagnostic purposes.
113. Requires anesthesia and sterile environment.
114. Complications: infection, bleeding, Asherman’s syndrome.
115. Ensure empty bladder before procedure.
116. Monitor for signs of postoperative infection.
117. Provide pain management post-procedure.
118. Antibiotic prophylaxis reduces infection risk.
119. Counsel about normal post-procedure bleeding.
120. Follow-up to confirm uterine healing.

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b) Post-Abortion Care

121. Post-abortion care (PAC) includes management of complications and counseling.
122. Monitor for signs of infection, bleeding, incomplete abortion.
123. Antibiotics reduce the risk of post-abortion sepsis.
124. Provide pain relief for cramping.
125. Monitor vital signs for signs of shock.
126. Ensure emotional support and psychological counseling.
127. Counsel on contraceptive options post-abortion.
128. Educate about danger signs: severe pain, fever, heavy bleeding.
129. Perform ultrasound if incomplete abortion is suspected.
130. Encourage early follow-up for post-abortion check-up.
131. Screen for anemia and provide iron supplements if needed.
132. Offer post-abortion family planning services.
133. Ensure confidentiality and non-judgmental care.
134. Address emotional trauma and mental health concerns.
135. In cases of unsafe abortion, provide comprehensive emergency care.
136. Monitor for thromboembolic events post-procedure.
137. Encourage hydration and proper nutrition for recovery.
138. Educate on future pregnancy planning.
139. Rhesus-negative women should receive anti-D immunoglobulin.
140. Provide peer support groups if available.
141. Address reproductive health rights and safe abortion practices.
142. Educate on menstrual changes post-abortion.
143. Advise on avoiding intercourse until bleeding stops.
144. Discuss risks of repeat abortions and prevention strategies.
145. Provide emergency contraception if needed in the future.
146. Refer for specialist care if complications arise.
147. Ensure access to counseling services for grief support.
148. Monitor for signs of post-abortion depression.
149. Encourage open communication with healthcare providers.
150. Promote comprehensive reproductive health education.

Drugs Used in Obstetrics.

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a) Indication, Dose, Action, Contraindication, Side Effects, and Responsibilities in the Administration of Obstetric Drugs

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Oxytocin

1. Oxytocin stimulates uterine contractions.
2. Indications: labor induction, augmentation, postpartum hemorrhage (PPH) control.
3. Dose: 5–10 IU IM or 10–20 IU in 500 mL IV infusion.
4. Action: binds to uterine receptors causing contractions.
5. Contraindications: CPD, fetal distress, malpresentation.
6. Side effects: uterine hyperstimulation, water intoxication, hypotension.
7. Monitor fetal heart rate (FHR) during administration.
8. Use with caution in women with previous uterine scar.
9. Titrate dose carefully to avoid hypertonic contractions.
10. Discontinue immediately if signs of uterine rupture.

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Uterotonics

11. Uterotonics promote uterine contractions to prevent/control PPH.
12. Includes drugs like methylergometrine, carboprost, misoprostol.
13. Methylergometrine dose: 0.2 mg IM or IV.
14. Contraindicated in hypertensive women due to vasoconstriction.
15. Carboprost dose: 250 mcg IM every 15–90 mins (max 2 mg).
16. Side effects: nausea, vomiting, diarrhea, hypertension.
17. Misoprostol dose: 600 mcg orally or 800 mcg rectally for PPH.
18. Store in cool, dry conditions to maintain potency.
19. Ensure emergency resuscitation equipment is available.
20. Educate the patient about possible side effects.

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Tocolytics

21. Tocolytics inhibit uterine contractions to delay preterm labor.
22. Examples: nifedipine, terbutaline, magnesium sulfate.
23. Nifedipine dose: 10–20 mg orally, repeat if needed.
24. Contraindicated in hypotension and cardiac conditions.
25. Terbutaline dose: 0.25 mg SC every 20 mins (max 3 doses).
26. Magnesium sulfate also used as a tocolytic in preterm labor.
27. Side effects: tachycardia, palpitations, hypotension.
28. Monitor for signs of pulmonary edema.
29. Check deep tendon reflexes with magnesium sulfate therapy.
30. Calcium gluconate is the antidote for magnesium toxicity.

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Antihypertensives

31. Used to manage pregnancy-induced hypertension (PIH).
32. Common drugs: labetalol, nifedipine, methyldopa.
33. Labetalol dose: 20 mg IV bolus, repeat as needed.
34. Contraindicated in asthma and heart failure.
35. Methyldopa dose: 250 mg orally 2–3 times daily.
36. Side effects: drowsiness, dry mouth, bradycardia.
37. Monitor BP closely during therapy.
38. Avoid ACE inhibitors and ARBs in pregnancy.
39. Ensure gradual BP reduction to avoid fetal compromise.
40. Counsel on the importance of adherence to therapy.

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Anticonvulsants

41. Used to control eclampsia seizures.
42. Magnesium sulfate is the drug of choice for eclampsia.
43. Loading dose: 4–6 g IV over 15–20 minutes.
44. Maintenance dose: 1–2 g/hr IV infusion.
45. Monitor for respiratory depression and loss of reflexes.
46. Side effects: flushing, nausea, muscle weakness.
47. Contraindicated in myasthenia gravis.
48. Calcium gluconate is the antidote for toxicity.
49. Monitor urine output to prevent accumulation.
50. Ensure availability of resuscitation equipment during administration.

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Anesthesia and Analgesia

51. Used for pain relief during labor and surgery.
52. Epidural anesthesia provides effective pain control in labor.
53. Spinal anesthesia is common in C-sections.
54. General anesthesia reserved for emergencies.
55. Side effects: hypotension, bradycardia, respiratory depression.
56. Contraindications: coagulopathy, infection at puncture site.
57. Monitor BP and FHR during epidural administration.
58. Ensure airway management skills in case of general anesthesia.
59. Provide emotional support during anesthesia procedures.
60. Educate on risks of post-dural puncture headache.

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b) Drugs Used for Newborns

61. Vitamin K prevents bleeding disorders in newborns.
62. Dose: 1 mg IM at birth.
63. Hepatitis B vaccine given within 24 hours of birth.
64. BCG vaccine protects against tuberculosis.
65. Polio drops given at birth to prevent poliomyelitis.
66. Antibiotic eye ointment prevents ophthalmia neonatorum.
67. Caffeine citrate treats apnea in preterm infants.
68. Ampicillin and gentamicin used for neonatal sepsis.
69. Phototherapy for neonatal jaundice (not a drug but a key treatment).
70. Surfactant therapy for respiratory distress syndrome in preterms.
71. Glucose for treating neonatal hypoglycemia.
72. Iron supplements in preterm infants to prevent anemia.
73. Paracetamol for mild pain or fever in neonates.
74. IV fluids (dextrose, saline) maintain hydration.
75. Monitor for signs of drug toxicity in newborns.
76. Use weight-based dosing for neonatal medications.
77. Naloxone reverses opioid-induced respiratory depression.
78. Immunoglobulin for neonates exposed to infections.
79. Phenobarbital used to control neonatal seizures.
80. Ensure aseptic technique during drug administration.

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c) Teratogens – Effects of Drugs on Mother and Baby

81. Teratogens cause congenital anomalies when exposed during pregnancy.
82. Critical period: 3–8 weeks gestation (organogenesis phase).
83. Thalidomide causes limb deformities (phocomelia).
84. Isotretinoin leads to craniofacial, cardiac, and CNS anomalies.
85. ACE inhibitors cause renal dysgenesis and oligohydramnios.
86. Warfarin causes fetal warfarin syndrome: nasal hypoplasia, bone defects.
87. Valproic acid linked to neural tube defects (spina bifida).
88. Phenytoin causes fetal hydantoin syndrome: growth deficiency, cleft palate.
89. Methotrexate is highly teratogenic causing skeletal and CNS anomalies.
90. Alcohol causes fetal alcohol syndrome: facial anomalies, growth retardation.
91. Tetracyclines cause tooth discoloration and bone growth inhibition.
92. Lithium associated with Ebstein’s anomaly (cardiac defect).
93. NSAIDs cause premature closure of the ductus arteriosus.
94. Cytotoxic drugs lead to miscarriage, malformations, or fetal death.
95. Diethylstilbestrol (DES) causes vaginal adenocarcinoma in female offspring.
96. SSRIs can cause neonatal adaptation syndrome.
97. Opioids lead to neonatal abstinence syndrome.
98. Fluoroquinolones affect cartilage development in the fetus.
99. Antithyroid drugs can cause fetal hypothyroidism and goiter.
100. Hypervitaminosis A causes craniofacial and heart defects.

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d) Nursing Responsibilities in Drug Administration

101. Verify the right drug, dose, route, time, and patient.
102. Check for allergies before administration.
103. Ensure correct calculation of drug doses, especially in neonates.
104. Monitor for adverse drug reactions.
105. Educate the mother about medication side effects.
106. Document the drug administration accurately.
107. Monitor vital signs before and after drug administration.
108. Ensure proper storage of temperature-sensitive drugs.
109. Use aseptic techniques to prevent infections.
110. Double-check high-risk drugs with another nurse.
111. Provide emergency support for anaphylactic reactions.
112. Counsel on the importance of adherence to prescribed therapy.
113. Report any adverse drug reactions to the physician.
114. Ensure informed consent for off-label drug use.
115. Keep emergency drugs accessible during high-risk procedures.
116. Educate the mother about teratogenic risks of specific drugs.
117. Assess for signs of drug toxicity, especially in preterms.
118. Use oral syringes for accurate dosing in neonates.
119. Teach mothers about safe medication practices at home.
120. Review medication orders regularly to prevent errors.

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e) Common Emergency Drugs in Obstetrics and Neonatology

121. Adrenaline for anaphylaxis and neonatal resuscitation.
122. Atropine used in resuscitation to treat bradycardia.
123. Sodium bicarbonate for correcting metabolic acidosis.
124. Dopamine for hypotension in critically ill neonates.
125. Prostaglandins used to maintain ductus arteriosus in congenital heart defects.
126. Magnesium sulfate for severe preeclampsia and eclampsia.
127. Oxytocin for managing postpartum hemorrhage.
128. Tranexamic acid (TXA) used to control postpartum bleeding.
129. Labetalol for hypertensive emergencies in pregnancy.
130. Nitroglycerin for acute hypertensive crisis.
131. Naloxone to reverse opioid-induced respiratory depression.
132. IV fluids (normal saline, Ringer’s lactate) for shock management.
133. Antibiotics for maternal and neonatal infections.
134. Phenobarbital for controlling neonatal seizures.
135. Surfactant therapy for preterm infants with RDS.
136. Vitamin K to prevent hemorrhagic disease of the newborn.
137. Dextrose to treat neonatal hypoglycemia.
138. Hydralazine for controlling severe hypertension in pregnancy.
139. Betamethasone to promote fetal lung maturity in preterms.
140. Diazepam or lorazepam for seizure management in emergencies.
141. Furosemide for fluid overload in neonates.
142. Ranitidine to prevent stress ulcers in critically ill neonates.
143. Aminophylline for apnea of prematurity.
144. Heparin to prevent clot formation in certain maternal conditions.
145. Misoprostol for managing PPH and incomplete abortion.
146. IV iron for treating severe anemia in pregnancy.
147. Antimalarials like chloroquine during pregnancy when indicated.
148. Antiretroviral therapy (ART) for HIV-positive mothers and newborns.
149. Insulin for gestational diabetes management.
150. Epinephrine as part of neonatal resuscitation protocol.

Introduction to Gynecology.

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A) Introduction of Gynecology

1. Definition of Terms

1. Gynecology is the medical science dealing with diseases of the female reproductive system.
2. Obstetrics focuses on pregnancy, childbirth, and postpartum care.
3. Amenorrhea is the absence of menstrual periods.
4. Menorrhagia refers to heavy or prolonged menstrual bleeding.
5. Metrorrhagia is irregular uterine bleeding between periods.
6. Oligomenorrhea means infrequent menstrual periods.
7. Polymenorrhea refers to frequent menstrual cycles, less than 21 days apart.
8. Dysmenorrhea is painful menstruation.
9. Cryptomenorrhea refers to hidden menstruation due to obstruction.
10. Menopause marks the permanent cessation of menstruation.

2. History

11. The history of gynecology dates back to ancient Egypt and Greece.
12. Hippocrates is considered the father of gynecology.
13. Speculum was first used in ancient Roman medicine.
14. Marion Sims developed surgical techniques for vesicovaginal fistulas.
15. The Papanicolaou test (Pap smear) was introduced in the 1940s.
16. The discovery of hormonal contraceptives revolutionized reproductive health.
17. The development of laparoscopy advanced minimally invasive gynecologic surgery.
18. Endometriosis was first described in the 1920s.
19. Assisted reproductive technologies (ART) emerged in the 1980s.
20. Gynecology has evolved with advances in ultrasound and MRI imaging.

3. Examination

21. Gynecological examination includes history-taking and physical assessment.
22. Always ensure patient privacy and consent before examination.
23. Abdominal examination assesses for masses or tenderness.
24. Speculum examination visualizes the cervix and vaginal walls.
25. Bimanual examination assesses the uterus and adnexa.
26. Use a warm speculum to reduce discomfort.
27. Rectovaginal examination is used in evaluating pelvic masses.
28. Breast examination is part of routine gynecological evaluation.
29. Screen for cervical cancer with Pap smear during exams.
30. Observe for abnormal discharge, bleeding, or lesions.

4. Investigations

31. Pap smear screens for cervical dysplasia and cancer.
32. Transvaginal ultrasound is crucial for pelvic organ assessment.
33. Endometrial biopsy helps diagnose abnormal uterine bleeding.
34. Hysteroscopy allows direct visualization of the uterine cavity.
35. Laparoscopy is a minimally invasive technique to examine pelvic organs.
36. Hormonal assays assess endocrine disorders.
37. CA-125 is a tumor marker for ovarian cancer.
38. Urine pregnancy test confirms or excludes pregnancy.
39. Colposcopy evaluates abnormal Pap smear results.
40. Vaginal swabs detect infections like STIs.

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B) Puberty

1. Definition

41. Puberty is the period of sexual maturation during adolescence.
42. It involves the development of secondary sexual characteristics.
43. Puberty marks the onset of menarche in girls.
44. The average age of menarche is 12–13 years.
45. Precocious puberty occurs before age 8 in girls.
46. Delayed puberty is the absence of sexual development by age 13.
47. Puberty is controlled by the hypothalamic-pituitary-gonadal axis.
48. Hormones involved include FSH, LH, estrogen, and progesterone.
49. Thelarche refers to breast development.
50. Adrenarche is the development of pubic and axillary hair.

2. Development of Sex Organs in Females and Sexuality

51. Ovaries develop from the gonadal ridge during embryogenesis.
52. The Müllerian ducts form the uterus, fallopian tubes, and upper vagina.
53. External genitalia develop under the influence of estrogen.
54. Clitoris, labia minora, and labia majora form by the 12th week of gestation.
55. Sexuality encompasses biological, psychological, and social aspects.
56. Gender identity is how a person perceives themselves as male or female.
57. Sexual orientation refers to emotional and sexual attraction.
58. Disorders like Müllerian agenesis affect female reproductive development.
59. Turner syndrome (45, X0) causes gonadal dysgenesis.
60. Androgen insensitivity syndrome leads to female phenotype despite XY chromosomes.

3. Review of Menstrual Cycle

61. The menstrual cycle averages 28 days but ranges from 21–35 days.
62. Divided into follicular, ovulatory, and luteal phases.
63. FSH stimulates follicle development in the ovaries.
64. LH surge triggers ovulation around day 14.
65. The corpus luteum secretes progesterone post-ovulation.
66. Menstruation occurs due to progesterone withdrawal if no pregnancy occurs.
67. The proliferative phase is estrogen-dominant.
68. The secretory phase is progesterone-dominant.
69. Normal menstrual bleeding lasts 2–7 days.
70. Primary amenorrhea is the absence of menstruation by age 15.

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C) Premenstrual Syndrome (PMS)

71. PMS includes physical, emotional, and behavioral symptoms before menstruation.
72. Symptoms resolve with the onset of menstruation.
73. Bloating, breast tenderness, mood swings, and irritability are common.
74. Severe PMS is termed premenstrual dysphoric disorder (PMDD).
75. Exact cause unknown but linked to hormonal fluctuations.
76. Serotonin dysregulation may play a role in PMDD.
77. Lifestyle modifications improve symptoms: exercise, stress management.
78. SSRIs are effective for severe PMDD.
79. NSAIDs help with physical symptoms like cramps.
80. Dietary changes: reduce caffeine, alcohol, and salt intake.

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D) Disorders of Menstruation

1. Dysmenorrhea

81. Dysmenorrhea is painful menstruation.
82. Primary dysmenorrhea occurs without an underlying pathology.
83. Caused by increased prostaglandin production, leading to uterine cramps.
84. Secondary dysmenorrhea is due to conditions like endometriosis or fibroids.
85. Symptoms: cramping pelvic pain, nausea, headache.
86. NSAIDs are the first-line treatment.
87. Hormonal contraceptives reduce menstrual pain.
88. Heat therapy provides symptomatic relief.
89. Ultrasound helps rule out secondary causes.
90. Severe cases may require laparoscopy.

2. Cryptomenorrhea

91. Cryptomenorrhea is hidden menstruation due to outflow tract obstruction.
92. Causes: imperforate hymen, transverse vaginal septum.
93. Symptoms: cyclic pelvic pain without visible bleeding.
94. Diagnosis confirmed by pelvic ultrasound.
95. Treatment involves surgical correction of the obstruction.
96. Risk of hematocolpos (blood accumulation in the vagina).
97. May lead to infertility if untreated.
98. Primary amenorrhea with normal secondary sexual characteristics is a clue.
99. Requires early diagnosis to prevent complications.
100. Post-surgical prognosis is excellent.

3. Dysfunctional Uterine Bleeding (DUB)

101. DUB refers to abnormal uterine bleeding without organic cause.
102. Common in adolescents and perimenopausal women.
103. Caused by hormonal imbalances, especially anovulation.
104. Presents as irregular, prolonged, or heavy menstrual bleeding.
105. Exclusion of pregnancy is the first step in evaluation.
106. Ultrasound rules out structural causes like fibroids.
107. Endometrial biopsy may be needed in older women.
108. Hormonal therapy (OCPs, progestins) regulates cycles.
109. NSAIDs reduce menstrual flow.
110. Severe cases may require surgical interventions like endometrial ablation.

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E) Other Menstrual Disorders

111. Amenorrhea is the absence of menstruation for >6 months.
112. Primary amenorrhea: no menstruation by age 15.
113. Secondary amenorrhea: absence of periods after normal menstruation.
114. Causes: pregnancy, PCOS, hypothyroidism, pituitary tumors.
115. Progesterone challenge test helps diagnose hormonal causes.
116. Polycystic ovary syndrome (PCOS) causes irregular periods.
117. Hypothyroidism leads to menstrual irregularities.
118. Hyperprolactinemia can cause amenorrhea and galactorrhea.
119. Asherman’s syndrome results from uterine adhesions post-surgery.
120. Stress, weight loss, and excessive exercise cause hypothalamic amenorrhea.

Menorrhagia

121. Menorrhagia is excessive menstrual bleeding (>80 mL or >7 days).
122. Causes: fibroids, adenomyosis, coagulopathies.
123. Iron deficiency anemia is common with chronic menorrhagia.
124. Ultrasound helps identify structural abnormalities.
125. Tranexamic acid reduces menstrual blood loss.
126. Levonorgestrel IUD is effective in controlling bleeding.
127. Severe cases may need hysterectomy.
128. Rule out endometrial hyperplasia or cancer in older women.
129. Hormonal therapy is first-line management.
130. Surgical options include endometrial ablation.

Oligomenorrhea and Polymenorrhea

131. Oligomenorrhea: infrequent periods >35 days apart.
132. Common in PCOS and thyroid disorders.
133. Polymenorrhea: frequent periods <21 days apart.
134. Can be due to hormonal imbalances or infections.
135. Hormonal assays help identify endocrine causes.
136. Lifestyle modifications benefit women with PCOS-related oligomenorrhea.
137. Progestin therapy regulates cycles.
138. Stress management improves cycle regularity.
139. Monitor for metabolic syndrome in PCOS.
140. Pelvic infections can disrupt menstrual cycles.

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F) Final Key Points

141. Menstrual disorders can signal underlying health issues.
142. Early diagnosis prevents complications like infertility.
143. Hormonal imbalances are common causes of irregular cycles.
144. Ultrasound is essential in evaluating menstrual disorders.
145. Patient history is key to diagnosing menstrual irregularities.
146. Laparoscopy is the gold standard for diagnosing endometriosis.
147. Lifestyle changes play a major role in managing PCOS.
148. Anemia screening is important in heavy menstrual bleeding.
149. Psychological support is crucial for adolescents with menstrual issues.
150. Regular gynecological check-ups promote reproductive health.

Fertility and Infertility

1. Fertility is the ability to conceive and produce offspring.
2. Infertility is the inability to conceive after 1 year of unprotected intercourse.
3. Primary infertility refers to no prior pregnancies.
4. Secondary infertility occurs after previous pregnancy.
5. Male infertility causes include low sperm count, poor motility, and morphological defects.
6. Varicocele is a common cause of male infertility.
7. Erectile dysfunction impacts male fertility.
8. Hormonal imbalances like low testosterone affect sperm production.
9. Female infertility causes include ovulation disorders, tubal blockage, and uterine anomalies.
10. Polycystic ovary syndrome (PCOS) causes anovulation.
11. Endometriosis can lead to infertility due to adhesions.
12. Pelvic inflammatory disease (PID) causes tubal damage.
13. Thyroid disorders affect fertility in both genders.
14. Obesity and underweight can disrupt ovulation.
15. Age >35 reduces female fertility significantly.
16. Smoking and alcohol decrease fertility.
17. Semen analysis is the first investigation for male infertility.
18. Hormonal assays (FSH, LH, testosterone) evaluate male endocrine status.
19. Scrotal ultrasound detects varicocele or testicular pathology.
20. Hysterosalpingography (HSG) assesses tubal patency in females.
21. Transvaginal ultrasound evaluates ovarian and uterine structure.
22. Laparoscopy identifies endometriosis and tubal blockages.
23. Ovulation tracking with basal body temperature or LH kits.
24. Clomiphene citrate stimulates ovulation in anovulatory females.
25. Intrauterine insemination (IUI) places sperm directly into the uterus.
26. In vitro fertilization (IVF) involves fertilization outside the body.
27. Intracytoplasmic sperm injection (ICSI) injects a single sperm into the egg.
28. Donor sperm or eggs are options in severe infertility cases.
29. Surrogacy is used when the uterus is nonfunctional.
30. Assisted reproductive technologies (ART) include IVF, ICSI, IUI.

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Pelvic Infections

31. Vulvitis is inflammation of the vulva, causing redness, itching.
32. Bartholinitis is infection of Bartholin’s glands, causing painful swelling.
33. Vaginitis is inflammation of the vagina, causing discharge, odor, itching.
34. Trichomonas vaginitis presents with frothy, greenish-yellow discharge.
35. Moniliasis (Candidiasis) causes thick, white, curd-like discharge.
36. Bacterial vaginosis shows fishy-smelling discharge with clue cells.
37. Metritis is infection of the uterine lining.
38. Salpingitis is inflammation of the fallopian tubes, often from STDs.
39. Oophoritis is infection of the ovaries.
40. Cervical erosion presents with post-coital bleeding.
41. Pelvic abscess is a collection of pus in the pelvis.
42. Chronic pelvic infection causes persistent lower abdominal pain.
43. Pelvic inflammatory disease (PID) involves infection of the upper genital tract.
44. PID can cause infertility due to tubal scarring.
45. Pelvic tuberculosis causes chronic pelvic pain and menstrual irregularities.
46. Genital TB affects the fallopian tubes primarily.
47. Syndromic case management treats STDs based on symptoms without lab tests.

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Sexually Transmitted Diseases (STDs)

48. Syphilis is caused by Treponema pallidum.
49. Primary syphilis presents as a painless chancre.
50. Secondary syphilis causes skin rashes on palms and soles.
51. Tertiary syphilis can affect the nervous system and heart.
52. Gonorrhea is caused by Neisseria gonorrhoeae.
53. Gonorrhea presents with purulent discharge and dysuria.
54. Chlamydia often causes asymptomatic infections.
55. Genital warts are caused by HPV (Human Papillomavirus).
56. HPV types 16, 18 are linked to cervical cancer.
57. HIV attacks CD4 T cells, leading to AIDS.
58. HIV transmission occurs via blood, semen, vaginal fluids.
59. Antiretroviral therapy (ART) controls HIV replication.
60. Trichomoniasis causes foul-smelling, frothy vaginal discharge.
61. Herpes simplex virus (HSV) causes painful genital ulcers.
62. Bacterial vaginosis increases the risk of HIV transmission.
63. Pelvic inflammatory disease (PID) commonly follows chlamydia or gonorrhea.
64. Syphilis testing includes VDRL and RPR tests.
65. Gonorrhea diagnosis via NAAT (Nucleic Acid Amplification Test).
66. HPV vaccine prevents cervical cancer.
67. Cervicitis is inflammation of the cervix, often due to STDs.
68. Hepatitis B and C are sexually transmissible infections.
69. Genital ulcer disease (GUD) includes syphilis, chancroid, herpes.
70. Pelvic abscess may complicate untreated PID.
71. Cervical cancer screening with Pap smear detects early changes.
72. Syndromic approach treats symptoms like urethral discharge or ulcers.
73. Bartholin abscess requires incision and drainage.
74. PID can present with adnexal tenderness.
75. Trichomoniasis diagnosed with wet mount microscopy.
76. Bacterial vaginosis treated with metronidazole.
77. Candidiasis treated with antifungal agents like fluconazole.
78. Pelvic TB diagnosed with endometrial biopsy.
79. HIV ELISA is the screening test; Western blot confirms.
80. HPV warts treated with cryotherapy or topical agents.

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Management and Prevention

81. Barrier methods like condoms reduce STD risk.
82. Partner notification is essential in STD management.
83. Safe sex practices reduce STD transmission.
84. HPV vaccine given to adolescents for prevention.
85. PID treatment includes broad-spectrum antibiotics.
86. Gonorrhea treated with ceftriaxone.
87. Chlamydia treated with azithromycin or doxycycline.
88. Syphilis treated with penicillin G.
89. HIV treatment with ART improves lifespan.
90. Genital herpes managed with acyclovir.
91. HIV-positive mothers advised for safe delivery practices.
92. Regular STD screening in high-risk individuals.
93. Pelvic abscess drainage if unresponsive to antibiotics.
94. Hysteroscopy can detect uterine abnormalities causing infertility.
95. Infertility counseling supports emotional well-being.
96. Endometriosis treated with hormonal therapy or surgery.
97. PCOS managed with lifestyle changes and medications.
98. Tubal infertility may require IVF.
99. IUI is less invasive than IVF.
100. ART success depends on age and cause of infertility.

Fertility and Infertility (Continued)

101. Ovulation disorders are the leading cause of female infertility.
102. Luteal phase defect results in poor endometrial preparation for implantation.
103. Anti-sperm antibodies can cause immune infertility in males.
104. Testicular torsion affects sperm production if not treated promptly.
105. Klinefelter syndrome causes male infertility due to chromosomal abnormality.
106. Turner syndrome causes ovarian dysgenesis leading to infertility in females.
107. Androgen insensitivity syndrome leads to infertility in genetically male individuals.
108. Hypothyroidism disrupts ovulation and menstrual cycles.
109. Hyperprolactinemia suppresses ovulation, causing infertility.
110. Stress can alter hormonal balance, affecting fertility.
111. Anabolic steroids reduce sperm production in males.
112. Testicular biopsy helps diagnose causes of azoospermia.
113. Ovarian reserve testing measures AMH (anti-Müllerian hormone) levels.
114. Laparoscopy is the gold standard for diagnosing endometriosis.
115. Hysteroscopy is useful for evaluating the uterine cavity.
116. Tubal cannulation can treat mild tubal blockages.
117. Egg freezing preserves fertility in cancer patients.
118. Cryopreservation stores embryos for future IVF cycles.
119. Preimplantation genetic testing (PGT) screens embryos for genetic diseases.
120. Ovulation induction involves medications like letrozole.
121. Gonadotropins are used for ovarian stimulation in IVF.
122. Ovarian hyperstimulation syndrome (OHSS) is a risk of IVF treatment.
123. Embryo transfer is a key step in the IVF process.
124. Surrogacy involves another woman carrying the pregnancy.
125. Gestational surrogacy uses the intended parent’s egg and sperm.
126. Donor eggs are used when a woman’s own eggs are not viable.
127. Donor sperm is an option for severe male infertility.
128. IVF success rates decrease with increasing maternal age.
129. Obesity reduces the effectiveness of fertility treatments.
130. Lifestyle changes like weight loss improve ovulation.
131. Male fertility improves with antioxidant supplementation.
132. Frequent ejaculation can reduce sperm count temporarily.
133. Varicocele surgery improves sperm quality in some cases.
134. Clomiphene can induce ovulation in men with low testosterone.
135. Infectious causes like mumps orchitis affect fertility.
136. Tuberculosis (TB) can cause genital tract scarring, leading to infertility.
137. Radiation therapy affects spermatogenesis and ovarian reserve.
138. Chemotherapy can lead to premature ovarian failure.
139. Premature ovarian insufficiency leads to early menopause.
140. Menopause naturally results in the loss of fertility.
141. Postpartum infertility can occur due to Sheehan’s syndrome.
142. Hypogonadotropic hypogonadism causes infertility due to low FSH/LH.
143. Sperm washing is used in IUI to prepare sperm.
144. Blastocyst transfer in IVF improves implantation rates.
145. Intracytoplasmic morphologically selected sperm injection (IMSI) selects the best sperm for IVF.
146. Assisted hatching helps embryos implant during IVF.
147. Luteal support with progesterone improves IVF success.
148. PCOS management includes metformin for insulin resistance.
149. Endometrial biopsy checks for chronic endometritis in infertility.
150. Mullerian anomalies cause congenital uterine malformations.

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Pelvic Infections (Continued)

151. Vulvitis often results from poor hygiene or infections.
152. Bartholin cyst forms due to blockage of Bartholin gland duct.
153. Bartholinitis presents as a painful swelling near the vaginal opening.
154. Abscess formation is common in untreated Bartholinitis.
155. Vaginitis may be bacterial, fungal, or parasitic in origin.
156. Trichomoniasis is sexually transmitted, caused by Trichomonas vaginalis.
157. Strawberry cervix is a classic sign of Trichomoniasis.
158. Moniliasis (Candida infection) occurs commonly after antibiotic use.
159. Candidiasis causes intense itching and burning sensation.
160. Metronidazole is the drug of choice for Trichomoniasis.
161. Fluconazole is effective against Candida infections.
162. Metritis often occurs postpartum or after miscarriage.
163. Postpartum endometritis presents with fever, foul discharge.
164. Salpingitis can cause ectopic pregnancy due to tubal scarring.
165. Oophoritis is often associated with mumps in adolescent girls.
166. Pelvic abscess requires antibiotics and sometimes surgical drainage.
167. Chronic pelvic infections can cause dyspareunia and chronic pain.
168. Pelvic tuberculosis presents with infertility and menstrual irregularities.
169. Genital TB spreads from pulmonary TB.
170. Cervical erosion can be mistaken for cervical cancer.
171. Cervical erosion treated with cryotherapy or cauterization.
172. Syndromic case management helps manage STIs without lab facilities.
173. PID leads to Fitz-Hugh-Curtis syndrome (liver capsule inflammation).
174. Tubal-ovarian abscess is a severe complication of PID.
175. Bacterial vaginosis increases risk of preterm birth in pregnancy.
176. HPV infection can cause cervical dysplasia.
177. Chlamydia is known as the silent infection due to mild symptoms.
178. Cervical cancer screening starts at age 21.
179. Gonorrhea often coexists with Chlamydia infection.
180. Partner treatment is mandatory in STIs to prevent reinfection.

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Sexually Transmitted Diseases (STDs) (Continued)

181. Syphilis progresses through primary, secondary, latent, and tertiary stages.
182. Chancre in primary syphilis is painless.
183. Latent syphilis has no visible symptoms.
184. Neurosyphilis occurs in untreated syphilis, affecting the nervous system.
185. Congenital syphilis results from transmission from mother to fetus.
186. Gonorrhea can cause ophthalmia neonatorum in newborns.
187. HIV/AIDS leads to opportunistic infections due to low immunity.
188. HPV types 6 & 11 cause genital warts.
189. Hepatitis B is more infectious than HIV.
190. Chancroid causes painful genital ulcers.
191. Lymphogranuloma venereum (LGV) causes painless ulcers with swollen lymph nodes.
192. Bacterial vaginosis diagnosed with Amsel’s criteria.
193. HSV-2 causes recurrent genital herpes.
194. Syphilis screening in pregnancy prevents congenital infections.
195. HIV window period is the time between infection and detectable antibodies.
196. Zidovudine (AZT) is used to prevent HIV mother-to-child transmission.
197. HPV vaccination recommended for both males and females.
198. Genital herpes has no cure but can be controlled with antivirals.
199. Crab louse (pubic lice) causes intense genital itching.
200. Molluscum contagiosum presents with pearly papules in genital area.

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Management and Prevention (Continued)

201. Condom use reduces transmission of HIV and STIs.
202. Screening programs are key in controlling STDs.
203. Antiretroviral therapy (ART) prolongs life in HIV patients.
204. Cervical cancer screening prevents HPV-related cancers.
205. Contact tracing helps prevent STI spread.
206. Post-exposure prophylaxis (PEP) prevents HIV after exposure.
207. Pre-exposure prophylaxis (PrEP) reduces HIV risk in high-risk groups.
208. Gonorrhea is becoming antibiotic-resistant globally.
209. Partner therapy reduces STI reinfection risk.
210. HPV testing is part of cervical cancer screening.
211. Pregnant women are screened for syphilis, HIV, hepatitis B.
212. Antibiotic resistance is a challenge in managing gonorrhea.
213. Abstinence is the only 100% effective method to prevent STDs.
214. Hepatitis B vaccine provides lifelong protection.
215. Herpes outbreaks triggered by stress or illness.
216. Genital hygiene reduces risk of infections.
217. PID requires hospitalization if severe.
218. Infertility workup includes hormonal, structural, and genetic assessments.
219. HPV vaccine is most effective before sexual debut.
220. ART includes drugs like tenofovir, lamivudine, efavirenz.
221. Post-coital bleeding may indicate cervical pathology.
222. Proctitis can result from rectal STIs.
223. Hepatitis C has no vaccine but is curable with antivirals.
224. Pelvic abscess may need surgical drainage.
225. Safe sex includes condoms, dental dams, and regular testing.
226. Genital ulcers need prompt evaluation to rule out STIs.
227. HPV 16 & 18 cause 70% of cervical cancers.
228. Pap smear detects precancerous cervical changes.
229. Chlamydia is often asymptomatic, especially in women.
230. Gonorrhea untreated can cause arthritis-dermatitis syndrome.
231. HIV-positive individuals need lifelong ART.
232. Zidovudine reduces mother-to-child HIV transmission during birth.
233. Regular STI testing is advised for sexually active individuals.
234. Pelvic TB requires long-term anti-tubercular therapy.
235. Female genital mutilation (FGM) increases infection risks.
236. Syndromic management is cost-effective in resource-limited settings.
237. Vaccination prevents hepatitis B and HPV.
238. Perinatal HIV transmission prevented with ART.
239. Contraceptives do not protect against STDs, except condoms.
240. Prevention of mother-to-child transmission (PMTCT) is key in HIV programs.

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General Key Points

241. Oophoritis affects ovarian function, leading to infertility.
242. Salpingitis often causes tubal blockage.
243. Ectopic pregnancy risk increases with prior PID.
244. Tubo-ovarian abscess presents with severe pelvic pain.
245. Fitz-Hugh-Curtis syndrome causes liver capsule inflammation in PID.
246. Infertility clinics offer ART services.
247. Ovarian cysts may cause pelvic pain or be asymptomatic.
248. Bacterial vaginosis disrupts normal vaginal flora.
249. Yeast infections thrive in warm, moist environments.
250. Genital hygiene helps prevent infections.
251. Gonorrhea and chlamydia often co-infect together.
252. Tuberculosis can infect the female reproductive tract.
253. Endometrial biopsy aids in diagnosing chronic infections.
254. Antibiotics treat most bacterial STIs.
255. HIV/AIDS managed with lifelong ART.
256. Syphilis has a latent stage without symptoms.
257. Genital herpes remains dormant in nerve ganglia.
258. Semen analysis evaluates sperm count, motility, morphology.
259. Hysterosalpingography (HSG) checks for tubal blockages.
260. Cervical cancer screening reduces mortality.
261. Ovarian torsion is a surgical emergency.
262. Pelvic exam essential for evaluating pelvic infections.
263. Dysmenorrhea can be a sign of endometriosis.
264. Fibroids can cause heavy menstrual bleeding.
265. Bicornuate uterus is a type of congenital anomaly.
266. Menstrual irregularities may indicate hormonal issues.
267. HPV vaccine prevents most cervical cancers.
268. Cervical ectropion appears as a red area on the cervix.
269. Breast examination is part of routine female health check-ups.
270. Menopause marks the end of natural fertility.
271. Ectopic pregnancy presents with unilateral pelvic pain.
272. Vaginal pH helps diagnose infections.
273. Pelvic TB diagnosed via biopsy or laparoscopy.
274. Infertility can cause emotional distress.
275. Condoms reduce STD and HIV transmission.
276. IVF success depends on age and egg quality.
277. HPV screening detects high-risk strains.
278. Bacterial vaginosis increases risk of HIV acquisition.
279. Recurrent miscarriages may indicate genetic or immune issues.
280. Anovulation causes irregular periods.
281. Hormone tests help diagnose infertility causes.
282. Sperm motility affects the ability to fertilize the egg.
283. Luteal phase defect causes implantation failure.
284. IUDs may slightly increase risk of PID after insertion.
285. Prolactin levels affect ovulation.
286. Hypothyroidism causes menstrual irregularities.
287. PID may cause adhesions in the pelvis.
288. Bilateral tubal blockage requires IVF for pregnancy.
289. Syndromic management reduces STD complications.
290. Oral contraceptives regulate cycles but don’t protect from STDs.
291. Safe sex education reduces STD prevalence.
292. ART includes IUI, IVF, ICSI, surrogacy.
293. Cervicitis presents with mucopurulent discharge.
294. Trichomonas diagnosed via wet mount microscopy.
295. Oophoritis may result from mumps infection.
296. Hysteroscopy evaluates the uterine cavity.
297. Chlamydia causes silent PID.
298. HPV DNA test screens for cervical cancer risk.
299. VDRL is used for syphilis screening.
300. Comprehensive sexual education reduces STD rates.

1. Uterine Position and Displacement

1. Retroversion is the tilting of the uterus backward toward the rectum.
2. Retroflexion refers to the uterus being bent backward at the cervix.
3. Uterine displacement includes anteversion, retroversion, anteflexion, retroflexion.
4. Congenital retroversion is present from birth.
5. Acquired retroversion can result from childbirth, pelvic infections, or tumors.
6. Symptoms of retroversion include lower back pain, dyspareunia, and menstrual irregularities.
7. Bimanual pelvic examination helps detect uterine position.
8. Pessary insertion helps manage symptomatic retroversion.
9. Uterine prolapse is the descent of the uterus into the vaginal canal.
10. Procidentia refers to complete uterine prolapse outside the vaginal introitus.
11. Risk factors for prolapse include multiparity, obesity, aging, and pelvic floor weakness.
12. Symptoms of prolapse are vaginal bulge, pelvic pressure, and urinary issues.
13. Kegel exercises strengthen pelvic floor muscles.
14. Vaginal pessaries support prolapsed organs.
15. Hysterectomy is considered in severe uterine prolapse.

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2. Fistulas

16. A fistula is an abnormal connection between two body parts.
17. Vesicovaginal fistula (VVF) is between the bladder and vagina, causing continuous urine leakage.
18. Rectovaginal fistula (RVF) connects the rectum to the vagina, causing fecal leakage.
19. Obstructed labor is the leading cause of fistulas in developing countries.
20. Radiation therapy can cause fistulas post-cancer treatment.
21. Symptoms include incontinence, foul discharge, and recurrent infections.
22. Dye test helps diagnose vesicovaginal fistulas.
23. Surgical repair is the definitive treatment for fistulas.
24. Good perineal hygiene is essential post-surgery.
25. Early management of obstructed labor prevents fistula formation.

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3. Uterine Malformations

26. Congenital uterine malformations result from Müllerian duct anomalies.
27. Bicornuate uterus has two horns due to incomplete fusion.
28. Septate uterus has a fibrous septum dividing the uterine cavity.
29. Arcuate uterus is a mild indentation at the uterine fundus.
30. Didelphys uterus has two separate uterine cavities.
31. Symptoms include recurrent miscarriages, infertility, or dysmenorrhea.
32. Hysterosalpingography (HSG) helps detect uterine anomalies.
33. MRI provides detailed imaging of uterine structure.
34. Surgical correction like metroplasty improves fertility outcomes.
35. Unicornuate uterus increases risk of preterm birth.

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4. Cysts and Fibroids

36. Ovarian cysts are fluid-filled sacs in the ovary.
37. Functional cysts include follicular and corpus luteum cysts.
38. Polycystic ovary syndrome (PCOS) features multiple small cysts with hormonal imbalance.
39. Dermoid cysts contain hair, teeth, or fat (teratomas).
40. Cystadenomas can be serous or mucinous in nature.
41. Symptoms include pelvic pain, bloating, or asymptomatic.
42. Ultrasound is the first-line investigation for ovarian cysts.
43. Laparoscopic cystectomy removes large or symptomatic cysts.
44. Uterine fibroids (leiomyomas) are benign smooth muscle tumors of the uterus.
45. Intramural fibroids grow within the uterine wall.
46. Submucosal fibroids protrude into the uterine cavity.
47. Subserosal fibroids extend outward from the uterine surface.
48. Symptoms include heavy periods, pelvic pain, and pressure symptoms.
49. MRI helps differentiate fibroids from other masses.
50. Myomectomy preserves the uterus while removing fibroids.
51. Hysterectomy is definitive treatment for symptomatic fibroids.
52. Uterine artery embolization (UAE) shrinks fibroids by cutting blood supply.
53. GnRH analogs reduce fibroid size temporarily.

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5. Uterine Polyps

54. Endometrial polyps are benign overgrowths of the uterine lining.
55. Symptoms include irregular bleeding, especially between periods.
56. Transvaginal ultrasound detects polyps.
57. Hysteroscopic polypectomy is the treatment of choice.
58. Polyps can be associated with infertility or recurrent miscarriage.

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6. Tumors of the Reproductive Tract

59. Benign tumors include fibroids, cystadenomas, and dermoid cysts.
60. Malignant tumors include endometrial, cervical, ovarian, and vulvar cancers.
61. Cervical cancer is strongly linked to HPV infection.
62. Endometrial cancer presents with postmenopausal bleeding.
63. Ovarian cancer often presents late with bloating and pelvic pain.
64. Pap smear detects cervical precancerous changes.
65. CA-125 is a marker for ovarian cancer monitoring.
66. Biopsy is the gold standard for diagnosing reproductive cancers.
67. Surgery, chemotherapy, and radiation are key treatments.
68. HPV vaccine prevents most cases of cervical cancer.

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7. Palliative Care and Rehabilitation

69. Palliative care focuses on symptom relief in advanced disease.
70. Pain management is central in palliative care.
71. Opioids are used for severe cancer-related pain.
72. Psychological support improves quality of life in terminal illness.
73. Rehabilitation helps patients regain physical and emotional function post-treatment.

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8. Breast Disorders

74. Mastitis is breast inflammation common during breastfeeding.
75. Symptoms include pain, redness, swelling, and fever.
76. Staphylococcus aureus is the most common cause of mastitis.
77. Breastfeeding should continue during mastitis.
78. Antibiotics like dicloxacillin treat mastitis.
79. Breast engorgement is due to milk accumulation.
80. Frequent breastfeeding relieves engorgement.
81. Breast abscess is a pus-filled collection in the breast.
82. Incision and drainage (I&D) is required for abscesses.
83. Benign breast tumors include fibroadenomas and cysts.
84. Fibroadenoma is a firm, mobile, painless lump.
85. Breast cysts are fluid-filled and may fluctuate with the menstrual cycle.
86. Mammography screens for breast cancer.
87. Breast cancer is the most common cancer in women worldwide.
88. Risk factors include family history, BRCA mutations, hormone therapy.
89. Symptoms of breast cancer include lump, nipple discharge, skin dimpling.
90. Triple assessment includes clinical exam, imaging, and biopsy.
91. Lumpectomy or mastectomy are surgical options.
92. Tamoxifen is used for hormone receptor-positive breast cancer.
93. HER2-positive cancers respond to trastuzumab.
94. Lymphedema can occur after breast surgery.

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9. Menopause

95. Menopause is the cessation of menstruation for 12 consecutive months.
96. Average age of menopause is around 51 years.
97. Perimenopause is the transition phase leading to menopause.
98. Hot flashes are the most common symptom.
99. Vaginal dryness occurs due to decreased estrogen.
100. Mood changes, insomnia, and fatigue are common in menopause.
101. Bone density loss increases the risk of osteoporosis.
102. Hormone replacement therapy (HRT) alleviates menopausal symptoms.
103. Estrogen-only HRT is for women without a uterus.
104. Combined HRT (estrogen + progesterone) is used if the uterus is intact.
105. HRT increases risk of breast cancer and thromboembolism.
106. Calcium and vitamin D support bone health.
107. Weight-bearing exercises prevent osteoporosis.
108. Surgical menopause occurs after removal of ovaries.
109. Premature menopause is before age 40.
110. Menopausal hormone therapy (MHT) is prescribed for severe symptoms.
111. Cardiovascular risk increases after menopause.
112. Menopausal women should have regular health screenings.
113. Cognitive changes may occur during menopause.
114. Urinary incontinence can worsen after menopause.
115. Non-hormonal therapies include SSRIs for hot flashes.
116. Phytoestrogens in soy may reduce hot flashes.
117. Pelvic floor exercises help with urinary symptoms.
118. Healthy lifestyle reduces menopause-related health risks.
119. Osteoporosis screening with DEXA scan post-menopause.
120. Counseling helps women cope with menopausal changes.

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General Key Points

121. Vaginal atrophy is common post-menopause.
122. Uterine fibroids may shrink after menopause.
123. Postmenopausal bleeding always requires investigation.
124. Breast self-examination should be done monthly.
125. BRCA gene mutations increase breast and ovarian cancer risk.
126. Pap smear screening continues until age 65.
127. Colposcopy evaluates abnormal Pap smear results.
128. Endometrial hyperplasia can progress to cancer if untreated.
129. Pelvic ultrasound helps assess uterine and ovarian pathology.
130. Endometrial biopsy is done for postmenopausal bleeding.
131. Stress incontinence worsens post-menopause.
132. Hysterectomy removes the uterus.
133. Oophorectomy removes ovaries, causing surgical menopause.
134. Mastectomy may be radical or modified radical.
135. Nipple discharge can be a sign of breast cancer.
136. Paget’s disease of the breast presents as nipple eczema.
137. Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer.
138. Invasive ductal carcinoma is the most common breast cancer type.
139. Triple-negative breast cancer lacks hormone receptors and HER2.
140. Tamoxifen is a selective estrogen receptor modulator (SERM).
141. Aromatase inhibitors used in postmenopausal breast cancer.
142. Lactational mastitis occurs during breastfeeding.
143. Non-lactational mastitis occurs in non-breastfeeding women.
144. Breast pain (mastalgia) is common during the menstrual cycle.
145. Fibrocystic breast changes cause lumpy, tender breasts.
146. Galactorrhea is milky discharge not related to breastfeeding.
147. Prolactinoma causes galactorrhea due to high prolactin levels.
148. Benign breast lumps are more common in young women.
149. Early detection improves breast cancer survival rates.
150. Clinical breast exam recommended annually.
151. Genetic counseling for families with breast cancer history.
152. Duct ectasia causes greenish nipple discharge.
153. Breast MRI is useful in high-risk women.
154. Breast reconstruction possible after mastectomy.
155. Oncoplastic surgery combines cancer removal with cosmetic surgery.
156. Sentinel lymph node biopsy checks cancer spread.
157. Hormone therapy reduces breast cancer recurrence.
158. Mammography detects breast cancer early.
159. Core needle biopsy diagnoses breast lumps.
160. Fine needle aspiration (FNA) is less invasive but less accurate.
161. Lactational engorgement causes swollen, painful breasts.
162. Cold compresses relieve breast engorgement.
163. Breast abscess may follow untreated mastitis.
164. Diabetic mastopathy is a rare breast condition in diabetics.
165. Gynecomastia is male breast enlargement.
166. Male breast cancer is rare but possible.
167. Hormonal imbalance causes gynecomastia.
168. Radiation therapy treats breast cancer post-surgery.
169. Chemotherapy used for aggressive breast cancers.
170. Bone metastases common in advanced breast cancer.
171. Trastuzumab targets HER2-positive breast cancer.
172. Lymphedema managed with compression therapy.
173. BRCA testing guides cancer prevention strategies.
174. Early menopause increases osteoporosis risk.
175. HRT contraindicated in breast cancer history.
176. Non-hormonal lubricants relieve vaginal dryness.
177. Calcium supplements prevent bone loss post-menopause.
178. Vitamin D essential for calcium absorption.
179. Exercise reduces breast cancer risk.
180. Weight management lowers breast cancer recurrence.
181. Smoking increases cancer risk.
182. Alcohol raises breast cancer risk.
183. Regular screening saves lives.
184. Psychological support vital for cancer patients.
185. Palliative care improves end-of-life quality.
186. Pain management critical in advanced cancer.
187. Metastatic breast cancer is incurable but manageable.
188. Family history increases breast cancer risk.
189. Dense breast tissue increases cancer detection difficulty.
190. Hormonal contraceptives slightly increase breast cancer risk.
191. Breastfeeding reduces breast cancer risk.
192. Pregnancy before age 30 reduces risk.
193. Late menopause increases breast cancer risk.
194. Radiation exposure increases cancer risk.
195. Healthy lifestyle reduces overall cancer risk.
196. Genetic mutations like BRCA1/2 increase risk.
197. Oophorectomy reduces ovarian and breast cancer risk in high-risk women.
198. Preventive mastectomy reduces cancer risk in BRCA carriers.
199. Breast density is a risk factor for cancer.
200. Early detection is the key to cancer survival.