IMPORTANT : Number-dependant and number-including questions represent at least 30% of the total questions of a Gynecology&Obstetrics exam , numbers include

(doses,periods,percentages ..etc) ,, most of us don't pay attention to numbers , most of them are confusing , here is a brief including the main im...portant numbers in Obst. Curriculum of end of round exam (which are in red): ((Numbers are copied from the department Book)) **********************OBSTETRICS****************** ******** *Age of viability = 28 weeks gestation *30% of women experience slight bleeding in the first trimester *15-20% of all pregnancies end in spontaneous abortion *80% of all abortions occur in the 1st. Trimester & 20% in the 2nd trimester *Chromosomal anomalies count for >50% of cases of spontaneous abortion *50% or more of cases of threatened abortion will continue normally *Surgical evacuation of the uterus is done only if the uterus is less than 12 weeks gestation in size *Spontaneous expulsion of missed 2nd trimesteric abortion occurs within 2-4 weeks *Incidence of recurrent abortion = 1-2% of all pregnancies *Incidence of isthmic incompetence = 0.5-1 % *Isthmic incompetence surgery is done between 12-14 w. Gestation *Success rate of McDonald's operation = 75-80% *Disturbance of pregnancy in a rudimentary horn occurs at 4th or 5th m. *Tubal ectopic represents 99% of all ectopic pregnancies *Intrauterine gestational sac is seen by abdominal US at serum hCG level of 5000-5000 miu/ml and by vaginal US at 1000-2000 miu/ml *Theca-leutin cysts are present in about 50% of gestational trophoblastic diseases *Incidence of vesicular mole is < 1% of all pregnancies *Recurrence rate of vesicular mole = 1-2% *Prophylactic chemotherapy in acase of mole is indicated only with high risk pregnancies at hCG level of > 100,000 miu/ml & theca-leutin cysts of >6 cm in diameter *Malignant change of vesicular mole counts for 20% of all mole cases *Follow up by serum hCG level in a vesicular mole is done as : Weekly for 3 consecutive weeks then, Monthly for 3 consecutive months then, Every 2 months for a total 1 year *After normal pregnancy serum hCG level declines in 6 w. , however in vesicular mole it usually declines in about 9 weeks *Suspicion of melagnancy in a vesicular mole is present when serum hCG level doesn't dec. After 12 w. Or returns after decline *Incidence of Acc. Hge. = 1% *Incidence of placenta previa = 1/300-1/500 of all pregnancies *Normal CVP = 4-8 cmH2O *Perinatal mortality in concealed acc. Hge. =95% , but in revealed = 50% *Hypertensive disorders(in general) complicates 5-10% of all preg. *Incidence of PE superimposing chronic htn. = 20-25% *Chronic hypertension(not related to preg.) persists after preg. By > 12w. *Hypertension of preeclampsia resolves after pregnancy by 6 w. *Proteinuria of PE = >300mg/24h. *Proteinuria of severe PE = 5gm/24h. *Eclampsia complicates 1-2% of all cases of PE *HELLP syndrome complicates 2-4% of cases of PE

*Oliguria of PE is <30ml/h. *Dose of MgSO4 = 4-6 gm in 20% sol. IV or in 50% sol. repeated IM *Incidence of DM complicating preg. = 1/350 *Incidence of cong. Anomalies with gest. DM = 6-9% *Neonatal hypoglycemia is considered if neonatal bl. Glucose <30mg% *Macrosomia is defined as fetal weight > 4 kg. *Daily caloric req. Of a diabetic pregnant mother = 30-35Kcal/kg/d. (with at least 50% carbs) *HbA1c > 10% suggests uncontrolled diabetes in the last 2-3 m. *Blood GGT 100gm oral gluc. for a pregnant diabetic mother = Fasting 90: 1h. 165 : 2h. 145 : 3h. 125 *Rh ve population = 15% *Incidence of erythroblastosis fetalis < 1% *Kernicterus occurs at >20% hyperbilirubinemia *Dose of AntiD Ig = 300 mcg (after preg.&at 28 w. gestation) *L/S ratio indicating fetal lung maturity = 2/1 *Pethidine(pain relief) in 1st. of labor = 50 mg IV *Amount of blood loss in episiotomy = 100-200 cc & in C.S = up to 600 cc *PPH is suspected when bl. loss after episiotomy > 500 cc & after C.S > 1000 cc *Incidence of OP = 25% *OP is delivered vaginally in 96% of cases (in spontaneous deflexion correction & DOP) *OP is delivered C.S in 4% of cases (POOP-DTA) *Incidence of breech = 3-4% *ECV is done at 36-37 w. gestation *Rate of performing CS in breech reaches 80% of cases *Incidence of multifetal pregnancy= 1-2 % *Incidence of twin in multifetal preg. = 97% *Incidence of monozygotic twins = 1/250 (constant worldwide) *Incidence of dizygotic twins = 1/89 (variable) *Period of rest of the uterus bet. The delivery of the 1st. & the 2nd. twin = 10-15 min. *Twins are discordant when the difference in weight bet. both is >25% *If a twin dies in the 2nd trimester , the other twin is suspected to be affected by 20% possibility *Grand multipara represent >90% of causes of rupture uterus *USCS represent 4-9% of cases of rupture uterus *LSCS represent 0.2-1.5% of cases of rupture uterus *PPH represents 34% of MMR in Egy. *Incidence of PPH = o.5-4% Atonic PPH represents 75-80% of cases of PPH *Active management of 3rd stage of labor decreases the incidence of PPH by 50% . ************************************* ****Notice that : 1.Items are put in the same sequence of chapters in the department book starting from abortion ending in rupture uterus . 2. Antenatal care & Diagnosis of pregnancy are not included because they should be studied from A to Z ,,,

**********************GYNCOLOG Y******************* ********** *Normal menstrual cycle : Average period = 3-7 d. (5d.)

Average amount = 30-50 cc Average interval = 24 32 d. (28d.) *Female ovary at time of puberty contains about 400,000 primordial follicles *Follicular phase = 14 d. (variable) *Luteal phase = 14 d. (constant) *Life span of CL = 9 d. *Ovulation takes place 36 h. after LH surge & 12 h. after LH peak *Placenta starts steroidogenesis at 8th w. gestation *Decidua basalis represents 25% of the endometrial thickening *Normal Spinbarkeit test (cervical mucus threads 7-10 cm.) * PrimaryAmenorrhea: Absence of menses with 2ry sexual ch. at 16y. Absence of menses without 2ry sexual ch. at 14y. *Secondary Amenorrhea is cessation of menses for > 6m. *Incidence of Imperforate hymen = 0.1% *Complete or partial Mullerian agenesis(Rokitansky syndrome) is 44XX *Testicular feminization genotype is 44XY *Y-containing gonads in testicular feminization carries 20% risk of malignancy(gonadoblastoma) *Complete Turner is 45XO *Mosaic Turner is 46XX or 45XO *In premature ovarian failure FSH level is >40 ng/ml *Pituitary microadenomas are < 10mm. in diameter *Pituitary macroadenomas are >10mm. in diameter *Infantile uterus, body/cervix ratio = 1/1 *Adult uterus, body/cervix ratio = 2/1 *Doses of drugs used in ttt of hyperprolactinemia : Bromocryptine = 1-2 tablets daily(4-6 weeks) Cabergoline = 1/2 tablet twice weekly for 2weeks *Normal Prolactin level = 2.9-29 ng/ml *Prolactinomas are responsible for >90% of pituitary causes of anovulation & amenorrhea *PCO has LH/FSH = 2/1 (which is abnormal) *Rise in temp. in the 2nd half an ovulatory mens. Cycle = 0.2-0.3 *Midluteal serum progesterone is done 7 days after ovulation (at day 21 of the cycle) *PEB is done 2-3 d. before menstruation *Dose of CC = 50mg oral tablets twice daily for 5 d. starting from 5th day of the cycle *Success rate of CC in induction of ovulation = 85% *Dose of Tamoxifen : 10-40mg daily orally for 5 d. starting from the 2nd day of the cycle *HMG contains 75IU FSH + 75IU LH *Purified FSH contains 75IU FSH + 1IU LH *hCG is given as 2 ampoules 5000 m/IU each as a single IM inj. *Incidence of PCOS = 5-10% of women in the reproductive age *In LPD the luteal phase of the cycle is shortened to be < 11 d. * Levels of P,E2,Prolactin,T,FSH,LH are all calculated in (ng) *MPHG is sometimes associated with small ovarian follicular cyst < 5cm in diameter *A cut-off value for endometrial thickness in menopause > 5mm is suspicious for hyperplasia, and that > 10mm is suspicious for malignancy *Anaerobes:Aerobes among vaginal flora = 10:1 *Normal vaginal pH = 3.8-4.5 *pH of vagina in BV = 4.7-7 *50% of cases of BV are asymptomatic

*Gardnerella Vaginalis may grow normally in the vagina of over than 50% of normal women *30% of cases of BV recur after treatment within 3 m.

*CDC regimen of BV : Metronidazole(tablets) 500 mg Clindamycin(tablets) 300 mg Metronidazole(gel) 5 g Clindamycin(cream) 5 g

*About 30% of women have candidal colonization in their vagina with no symptoms *Budding yeast under microscope is seen in 50-70% of yeast infected women

*CDC regimen of CV : Topical : butaconazole 5g (3d.)-miconazole 5g(7d.)-nystatin(100,000 U)(14d.) Oral : Fluconazole single oral dose(150mg)-Ketoconazole(in recurrent cases) *Metronidazole in ttt of trichomoniasis is given 1 g orally

*Male sexual partner should be treated by metronidazole,otherwise he will be reinfected by 25%

*Risk of prolapse increases by 1.2 times with each vaginal delivery *Incidence = 20% of women over the age of 30 (1 in every 5 women) *Corporeal fibroids represent 96% _ Cervical 4 % *Sarcomatous in change of a myoma occurs in 0.2-0.5 % of cases *30% of case of fibroid present with menorrhagia *Small myoma gives a uterine size of < 12 w.,if more it indicates degeneration *Medical ttt of fibroid is indicated when the uterus is < 12 w. , however surgical management is indicated when it becomes > 14 w. *Incidence of Endometriosis = 20 % of women in the childbearing period *In mild cases of fibroid, but with severe symptoms, pseudopregnancy or pseudomenopause is created along a duration of 6m. to 2y. *Male factor represents 30-40% of causes of infertility *Female factor represents 40-50% of causes of infertility *The cause of infertility is unexplained in 10-15% of cases *Normal Semen parameters : Vol. = 2-5 ml Conc./ml = >20 million sperms/ml Total spermatic count = >40 million/ml Progression >50% Motility >50% Morphology >30% normal forms(oval head&single head) WBC's < 1 milloion/ml *Ovarian factor is the commonest cause of female infertility 30-40%

*Decreased ovarian reserve is detected by high FSH level on dat 3 of the cycle (>10ng/ml) *HSG is performed 2-3 days after menses *Post Coital Test is done 6-10 hours after intercourse *Cu-T may be 380 or 200(Nova-T) *Cu-T IUD is changed every 6-8 years *Mirena IUD is changed every 3-4 years *IUD is inserted on the last day of menses,4-6 weeks after delivery & 3-4 weeks after abortion *IUD threads are cut 2 cm. from the ext. os *Failure rate of IUD = 0.5/HWY *Cu-IUD inc. blood loss by 35% *Mirena dec. blood loss by 70% *Abortion rate in pregnancy on IUD = 50% if threads are not seen & 25% if threads are seen and IUD is removed *COC monophasic pills are given on day 3 or 4 of menstruation for 21 d. followed by 7 d. free period , shedding occurs 3-4 d. after stopping COC *Vaginal ring is applied on day 3-4 of menstruation for 21 d. followed by 7 d. ring free period to allow withdrawal *Contraceptive patches are given on day 3-4 of menstruation for 21 d. (changed every one week) followed by 7 d. patch free period to allow withdrawal *Failure rate of hormonal contraceptive method = 0.1-1/HWY *Progestin only injectables are given every 3 m. IM *Subdermal progestin Implants give 3 y. contraception *During lactation 40-60% of women will experience amenorrhea&anovulation in the first few months *IUD is inserted post-coitaly for emergency contraception within 24-48 h. *POP are given post-coital immediately as 1st dose followed by 2nd dose after 12 h. *POP or COC are given within 72 h. after coitus for emergency contraception

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