Basic mnemonics in obstetrics and gynaecology - part one
Studying medicine is not an easy task. Although it is good to understand every concept, some things need that we device a technique to remember them more easily. As part of our duties to make medical profession more interesting, we have decided to write on mnemonics in obstetrics and gynecology for easy learning of the course.
Note: this mnemonics are created by anonymous individuals.
Each of the conditions/items will be discussed under the following contents:
- Brief introduction
- Mnemonic proper
It is the combination of pregnancy induced hypertension and proteinuria with or without oedema
Preeclampsia: classic triad:
- Rising blood pressure
2. Right Lower Quadrant Pain in Female
This is the pain that result from the right lower part of the abdomen.
Some differentials are:
- Appendicitis/ Abscess
- Ectopic pregnancy/ Endometriosis
- Inflammatory disease (pelvic)/ IPD
- Ovarian cyst (rupture, torsion)
- Uteric colic/ Urinary stones
3. Abdominal Pain(causes during pregnancy)
Pain is a complex experience consisting of a physiological and a psychological response to a noxious stimulus.
Some differentials are:
- Ovarian tumour
- Rupture (eg. ectopic/ uterus)
- Rectus sheath haematoma
- Abruption of placenta
- Torsion of uterus
Protein produced by the liver of the human fetus, which accumulates in the amniotic fluid. A high or low concentration of this protein is an indication for certain conditions.
Causes of increased maternal serum AFP during pregnancy
“Increased Maternal Serum Alpha Feto Protein”:
- Intestinal obstruction
- Multiple gestation/ Miscalculation of gestational age/ Myeloschisis
- Spina bifida cystica
- Anencephaly/ Abdominal wall defect
- Fetal death
- Placental abruption
- Testicular tumours
- Obituary (fetal death)
- Liver: hepatomas
- Defects (neural tube defects)
Causes of decreased maternal serum AFP during pregnancy
- Edward syndrome
- Down syndrome
5. APGAR SCORE
Method of judging the condition of a newborn baby in which the baby is given a maximum of two points on each of five criteria which are
- Skin color: blue or pink
- Heart rate: below 100 or over 100
- Irritability (response to stimulation): none, grimace or cry
- Respirations: irregular or good
- Tone (muscle): some flexion or active
6. Asherman’s Syndrome Features
Asherman's syndrome is an uncommon, acquired, gynecological disorder characterized by changes in the menstrual cycle.
- Acquired Anomaly
- Secondary to Surgery
- HSG confirms diagnosis
- Endometrial damage/ Eugonadotropic
- Repeated uterine trauma
- Missed Menses
- Normal estrogen and progesterone
7. B-agonist tocolytic (C/I or warning)
Beta-adrenergic receptor agonists have been used for tocolysis in the setting of preterm labor for more than three decades.
- Angina (Heart disease)
- BP high
- Excessive bleeding
8. Chorionic Villus Sampling and amniocentesis: when performed?
Chorionic villus sampling, sometimes called "chorionic villous sampling", is a form of prenatal diagnosis to determine chromosomal or genetic disorders in the fetus. It entails sampling of the chorionic villus and testing it for chromosomal abnormalities, usually with FISH(Fluorescent In situ Hybridization) or PCR(Polymerase Chain Reaction).
Amniocentesis is a procedure which involves taking a test sample of the amniotic fluid during pregnancy using a hollow needle and syringe.
"Chorionic" has 9 letters and Chorionic villus sampling performed at 9 weeks gestation.
"AlphaFetoProtein" has 16 letters and it's measured at 16 weeks gestation.
9. Delivery: instrumental delivery prerequisites
- Bowel empty
- Bladder empty
- Cephalic presentation
- Dilated cervix
- Disproportion (no CPD)
10. Dysfunctional uterine bleeding (DUB): 3 major causes
DUB is defined as "abnormal uterine bleeding that is not associated with uterine pathology or medical illness. So it is a diagnosis of exclusion.
- Don't ovulate (anovulation: 90% of cases)
- Unusual corpus leuteum activity (prolonged or insufficient)
- Birth control pills (since increases progesterone-estrogen ratio)
Read also: basic mnemonics in paediatrics
11. Early cord clamping: indications
The World Health Organisation (WHO) defines early cord clamping as the clamping of the umbilical cord within the first 60 seconds of birth.
- Rh incompatibility
- Premature delivery
- Diabetic mother
- CS (caesarian section) previously
12. Fetus: cardinal movements of fetus
The mechanisms of labor, also known as the cardinal movements, involve changes in the position of the fetus’s head during its passage in labor. These are described in relation to a vertex presentation.
The movements are:
"Don't Forget I Enjoy Really Expensive Equipment"
- Interal rotation
- External rotation
13. Forceps: indications for delivery
Forceps delivery is a type of assisted delivery in which forceps are used to aid in the delivery of the fetus by applying traction to the fetal head.
- Foetus alive
- Os dilated
- Ruptured membrane
- Cervix taken up
- Engagement of head
- Presentation suitable
- Sagittal suture in AP diameter of inlet
14. Forceps: indications for use
- Fully dilated cervix
- Outlet adequate (e.g. no CPD)
- Ruptured membranes
- Cephalic or at least deliverable presentation/ Contracting uterus
- Engaged head
- Surrounding structure empty (bladder and bowel)
15. Gestation period, oocytes, vaginal pH, menstrual cycle: normal numbers
Gestation period is the he period usually of days from conception to birth during which the baby develops in the mother’s womb.
Oocyte is a cell which forms from an oogonium and becomes an ovum by meiosis.
Vaginal PH is the level of acidity of the vaginal
Menstrual cycle is a cyclical process that involves changes in the ovaries and the lining of the uterus (endometrium), starting with the preparation of an egg for fertilization.
The normal numbers are:
- 4 is the normal pH of the vagina.
- 40 weeks is the normal gestation period.
- 400 oocytes released between menarche and menopause.
- 400,000 oocytes present at puberty.
- 28 days in a normal menstrual cycle.
- 280 days (from last normal menstrual period) in a normal gestation period.
16. Intrauterine Device(IUD): side effects
An intrauterine device (IUD), also known as an intrauterine contraceptive device (IUCD), is a small T-shaped plastic device with copper banded around the transverse arms, which is inserted into the uterus to prevent pregnancy.
Side effects are:
- Period that is late
- Abdominal cramps
- Increase in body temperature
- Noticeable vaginal discharge
17. Intrauterine Growth Restriction(IUGR): causes
Intrauterine growth restriction (IUGR) refers to a condition in which a fetus is unable to achieve its genetically determined potential size.
Some causes are:
- Inherited: chromosomal and genetic disorders
- Uterus: placental insufficiency
- General: maternal malnutrition, smoking
- Rubella and other congenital infection
18. Labour: preterm labor causes
Preterm labor is defined as the presence of uterine contractions of sufficient frequency and intensity to effect progressive effacement and dilation of the cervix after age of viability and before 37 weeks.
- Exercise (strenuous)
- Environmental factor (job, etc)
19. Complications of multiple pregnancy
Multiple pregnancy is a pregnancy in which more than one fetus develops in the uterus at the same time.
- Hydramnios (Poly)
- Preterm labour
- Antepartum haemorrhage
Read also: basic mnemonics in surgery
20. Oral contraceptive complications: warning signs:
Contraceptive is a device that can be used to intentionally prevent pregnancy.
Warning signs are:
- Abdominal pain
- Chest pain
- Headache (severe)
- Eye (blurred vision)
- Sharp leg pain
21. Oral contraceptives: side effects
- Cholestatic jaundice
- Oedema (corneal)
- Nasal congestion
- Thyroid dysfunction
- Raised BP
- Acne/ Alopecia/ Anaemia
- Cerebrovascular disease
- Elevated blood sugar
- Intracranial hypertension
- Vomiting (progesterone only)
- Erythema nodosum/ Extrapyramidal effects
- Sensitivity to light
22. Ovarian cancer: risk factors
This refers to the malignancy of the ovary. It often go undetected and therefore patient usually report at the advanced stage of the disease.
Risk factors are:
- Breast cancer
- Family history
- Low parity
23. Pelvic Inflammatory Disease (PID): complications
Pelvic inflammatory disease is characterized by inflammation and infection arising from the endocervix leading to endometritis, salpingitis, oophoritis, pelvic peritonitis and subsequently formation of tubo-ovarian and pelvic abscesses. The most causes are chlamydial and gonococcal infections however, other organisms, such as bacterial vaginosis, may be identified. It may be acute or chronic.
I FACE PID:
- Fitz-Hugh-Curitis syndrome
- Chronic pelvic pain
- Ectopic pregnancy
- Intestinal obstruction
- Disseminated: sepsis, endocarditis, arthritis, meninigitis
24. Postpartum collapse: causes
Maternal collapse is defined as an acute event involving the cardiorespiratory systems and/or brain, resulting in a reduced or absent conscious level (and potentially death).
- Pulmonary embolism
- Amniotic fluid embolism
- Regional anaethetic complications
- Infarction (MI)
- Neurogenic shock
- Septic shock
25. Causes of Post-partum haemorrhage
Post-partum haemorrhage is the blood loss after delivery, this may be primary which is within 24 hours of delivery or secondary which is between 24hours of delivery to 6week.
Blood loss of 500mls following vaginal delivery or 1000mls following caesarean section or any blood loss that results in cardiovascular compromise, irrespective of volume
Loss of fresh or frank blood after the lochia rubra has ended
- Tissue (retained placenta)
- Tone (uterine atony)
- Trauma (traumatic delivery, episiotomy)
- Thrombin (coagulation disorders, DIC)