Introduction to obstetrics and gynecology_060946.pptx

How to manage it

1. Introduction to obstetrics and gynecology Dr Mutale.

2. Obstetrics and gyneacology Obstetrics : a branch of medical science that deals with pregnancy, child birth and the postpartum period. Gynaecology : a branch of medicine that deals with diseases and routine care of the reproductive system of women

3. Course outline (overview) Semester 1 Part A ( gyneacology ) Gynaecological History Taking Physical Examination Review of Anatomy Female reproductive system Physiology of the menstrual cycle Disorders of the Menstrual Cycle Fertility Problems Contraceptives Infections Tumours (Benign and Malignant Genital Prolapse Incontinence Gynaecological Operations/Procedures

4. Expectations At the end of this course you should be able to. 1. Take a comprehensive gynaecological history 2. Examine a patient with gynaecological pathologies 3. Describe common gynaecological conditions 4. Interpret gynaecological clinical findings precisely 5. Order appropriate investigations 6. Demonstrate ability to manage appropriately common obstetric and gynaecological conditions

5. History taking Importance of history taking Builds connection with patient Outlines cause of the condition/disease Outlines the risk factors of the condition/disease Outlines the complications Treatment Pre- requisits Introduction Informed consent Privacy and confidentiality

6. Parts of history taking Demographics Name Date Informant Occupation Residence Religion Relationship status Gravidity/parity

7. History taking ctn.. Presenting Complaint What brought the patient to the hospital Must include duration History of presenting complaint Must contain detailed history of the present complaint including: How it started When it started What has been done so far Associated factors/constitutional symptoms. System/s involved must be reviewed here. Pain must be evaluated using s.o.c.r.a.t.e.s

8. History taking ctn.. Review of systems All other symptoms not reviewed in HOPC.

9. Obstestric & gynaecology history Present Obs history Gravidity Parity LMP/LNMP EGA EDD(expected day of delivery) ANC date of booking and gestational age Number of ANC visits Booking BP Any complications of pregnancy so far Prophylactic treatment Past Obs Hx Hx of every pregnancy Place of delivery (home, clinic, or hospital), mode and duration of labour Birth weight where possible Breast feeding and duration Any miscarriages-spontaneous/induced Any MVA done Any post abortal sepsis Any complications in the puerperium

10. Gynaecology hx Age at menarche Regularity of menses Duration and interval of menses Any dysmenorrhea Contraceptive use and duration Age at sex debut Number of partners Any STI’s Spouse circumcision status Any Pap smear/VIA and when

11. History taking ctn.. Past Medical & surgical History Hx of similar illness in the past Any hospital admissions in the past Any other illnesses in the past Hx of past surgery DM, Epilepsy, Asthma, TB, HTN, SCD, Blood dyscrasias , HIV status

12. Drug hx Drugs being taken Any herbs being taken Any allergies Any side effects noted

13. Relevant family history DM, Epilepsy, Asthma, TB, HTN, SCD, Blood dyscrasias Twinning Social Economic hX Marital Status Social habits: Smoking, alcohol Occupation Size of house Number of occupants Sanitation methods Use of ITN

14. Important positives Important negatives Eg In summary CM F/23, P1 self referral who presented with spontaneous onset progressive suprapubic pain started six hours prior. She has associated frequency, fever and dysuria. However no hematuria.

15. Impression: Differentials:

16. Clinical Examination General Condition : Pt was conscious/not conscious Febrile Pallor jaundice Cyanosis oedema lymphadenopathy dehydration

17. RS INSPECTION: chest; ?symmetrical, deformities scars; ? tatooes , surgical PALPATION: tenderness trachea; ?central chest mvts PERCUSSION: percussion AUSCALTATION: breath sounds; ?bronchial, vesicular added sounds vocal resonance CVS Distended neck veins Precordium Apex beat S1, S2 Added sounds

18. GYN EXAM Any visible sores or warts on vulva Any visible vagina discharge/PVB Condition of Cervix Soft Firm Hard regularity Any cervical excitation tenderness Any PVD/Contact bleeding (Pelvic vaginal discharge) OBS EXAM Symphysial Fundal Height (SFH) Presentation Number of gestations Lie Descent Adequacy of liquor volume Fetal heart sounds Baby’s back in relation to mother

19. MMS: Oedema Urinalysis: SG: Leukocytes: Nitrites: Bilirubin: Glucose: pH: blood: ketones: proteins:

20. CONCLUSION Final Impression Differential Diagnosis Investigations

21. Raison d’^ etre Is a French expression which means the most important reason for somebody’s or something’s existence. Our raison d’^ etre as a medical profession is the PATIENT . Without the PATIENT we are all out of work.

22. THE END QUESTIONS ?