Delivery of the placenta and membranes following injection of 5 units of oxytocin to the mother once the infant’s
shoulders are visible.
Absence of menstruation
This syndrome occurs typically after 20 weeks of gestation when the pregnant woman is lying in the supine position. In this position due to gravity the uterus is compressing the inferior vena cava, hence the blood flow returning from the legs is drastically decreased leading to maternal hypotension and decreased blood flow to the placenta.
The woman should be placed in the left lateral position.
(Rarely this lateral position is not possible, and one should gently perform a manual displacement of the uterus to the left of the midline by placing the hand on the right side of the abdomen and shifting the uterus to the left).
Lack of periods due to scar tissue forming inside the uterus;
This can be a complication of dilation and curettage or other medical procedures.
It is the presence of bacteria in the blood. It means that there is a positive blood culture.
It is a 100% silicon made balloon with a maximum inflation volume of 500ml.
It should be filled only with sterile liquid.
It is used as a second line treatment of Post Partum Hemorrhage (PPH) in case of failures of the first line measures (uterine massage+intravenous oxytocin+foley catheter insertion+uterine manual exploration+vaginal and cervical instrumental exploration) .
It can be used after a vaginal or a cesarean section delivery.
After being inflated it is recommended to check its correct placement using abdominal ultrasonography.
Sudden haemorrhage during vaginal delivery due to rupture of a velamentous vessel or of a praevia vessel. It happens typically during the rupture of the membranes. Facing benckiser haemorrhage require an immediate birth with a “red” code annoucement.
One should understand that some velamentous vessels or praevia vessels may be screened by endovaginal ultrasound using colour Doppler imaging during pregnancy. Such a discovery will lead to a planned caesarean section to avoid this haemorrhage.
Also known as the cervix scoring system.
It is based on digital cervical examination and use five parameters :
-cervical dilation (0/1/2/3)
-cervical effacment (0/1/2/3)
-fetal head station (0/1/2/3)
-cervix position (0/1/2)
-cervix consistency (0/1/2)
The score goes from zero to 13 point maximum.
A Score of 8 or greater is considered to be favorable to perform induction of labor.
Weight in kilograms divided by Height in meters x Height in meters
(Normal weight BMI = 25-29.9)
It is uterine contractions that are of physiological type.
These contractions are painless, irregular and do not shorten nor open the cervix.
These contractions help create the lower uterine segment (See the definiton of this word).
Cancer cells are located only in the place where they first formed and haven’t spread to nearby tissue
Chorionic Villi (CV) are the functional unit of the placenta, it is the place where the foeto maternal circulation stand.
CV can be distinguished as soon as the 12th day after fertilization.
In case of spontaneous clinical abortion, whenever it is possible, one should send the so called “gestational sac” for pathological examination and CV identification. CV detection will confirm the spontaneous abortion diagnosis; on the other hand if no CV are found ectopic pregnancy diagnosis should be discussed.
In case of ectopic pregnancy laparoscopic treatment, one should send the so called “ectopic pregnancy” for pathological examination and CV identification. If CV are not identified the ectopic pregnancy diagnosis can not be done.
“Red” code, “Orange” code and “Green” code correspond to situations with degrees of urgency from highest to lowest.
Red code are Very Urgent cases with expected decision to delivery interval of less than 15 minutes.
Orange code are Urgent cases with expected decision to delivery of less than 30 minutes.
Green code are Non Urgent cases with expected decision to delivery of less than 60 minutes.
Used since March 2003 by professor O Dupuis, and published for the first time in 2008. O Dupuis et al. EJOG 140;2008:206-211.
See on this website chapter “Journal articles”Red, orange and green Caesarean sections: a new communication tool for on-call obstetriicans.
Placenta and membrane delivery
Generalized tonic-clonic convulsions that develop in women with pre-eclampsia.
It is the first day of shedding of the lining of the uterus, the first day of vaginal bleeding.
Onset: beginning of labour
End: the woman has reached full dilation of cervix (10 cm)
Haemolysis (Drop in haemoglobin, drop in haptoglobin, LDH increase >600UI/l)
AND
Elevated liver enzymes (ASAT and ALAT > 2N)
AND
Low platelets (Platelets < 100 000 mm3)
Pregnancy in which both extra uterine and intra uterine gestation occurs simultaneously in the same woman.
This situation occurs especially in pregnancies following Assisted Reproduction Techniques (ART).
This situation is a major contra indication to the medical treatment of the ectopic pregnancy.
HPV are circular DNA virus of small size (52 nm), more than 200 types are known.
A number is given to each HPV virus.
Some are responsible for plantar wart (n°1,n°2,n°4,n°63), other for genital wart (n°6,n°11…), other for head and neck cancers, cervical cancer, vulvar cancer, anal cancer .. (n°16,n°18,n°33,n°35…)
HPV types that are responsible for cancers are named High Risk HPV or HPV-HR; fifteen genotypes are carcinogenic (16,18,31,33,35,39,45,51,52,56,58,66,68,70 and 82).
German virologist, Pr Zur Hausen has demonstrated that HPV-HR causes cancer and was awarded the Nobel prize in 2008.
The HPV-HR genome codes for E6 and E7 oncoproteins and those proteins inhibit two main genome gate keepers respectively p53 protein and retinoblastoma tumour suppression protein (pRB).
Gardasil 9 is a vaccine that protect against 7 HPV-HR types.
Hyperstimulation is tachysystole ( See the definition) or hypertonic contraction (See the definition) associated with fetal heart rate decelerations.
(Reference : Uterine Hyperstimulation The need for standard terminology. P Curtis, S Evens, J Resnick. J Reprod Med 1987; 32(2):91-95.)
A contraction with a duration of > 90 seconds is defined as “hypertonic”.
(Reference : Uterine Hyperstimulation The need for standard terminology. P Curtis, S Evens, J Resnick. J Reprod Med 1987; 32(2):91-95.)
Foetus with an Estimated Foetal Weight (EFW) less than the 10th percentile.
Serial sonography with at least two values on foetal growth curves are required. In fact a foetus with IUGR will “break their curves”
Level of serum hCG beyond which an intra-uterine pregnancy is normally visualized using transvaginal sonography (TVS).
This level value is 1500 IU/l.
This threshold is a key for ectopic pregnancy diagnosis. Indeed when a woman has a serum HCG level above this threshold ( for example 1700 IU/l) and no intra uterine pregnancy visualized by TVS, one should look for an ectopic pregnancy with TVS on the pain side.
The lower uterine segment is a part of the uterus that appears during pregnancy especially after 32 weeks of gestation.
It is created secondary to Braxton-Hicks contractions (See the definition of this word).
One should notice that a placenta praevia is a placenta located partially or totally on this lower uterine segment.
Delivery of the placenta and membranes performed by an OB Gyn with one hand introduced into the vagina and passed into the uterus, the placenta is peeled off then grasped and withdrawn.
Membrane sweeping (MS) is a clinical technique , the physician inserts one or two fingers in the cervical canal until he reaches the internal os and the membranes and touch the foetus head. Then he use a 360 degree circular motion to detaches (ie sweep) the membranes from the uterus.
MS produces hormones that give uterine contractions or rupture the membranes and can induce labour.
Clinical studies have shown that, on average, women could deliver 3 to 5 days after MS.
As for every medical examination, MS should be performed only if requested by the pregnant woman and after a clear explanation, that should mention the potential pain related to the procedure, has been given.
When requested, it can be performed several time in order to induce labor.
MS performed on maternal request should be performed only at 38 weeks or beyond.
Placenta praevia is an absolute contraindication to MS.
BMI of 30 or greater
The Obstetrical Rest is the rest that can sometimes apply to pregnant woman.
This rest has four important feature :
BMI range from 25 to 29.9
Synonym = abruptio placentae
It is the premature separation of the normally implanted placenta. It may be partial or total and lead to a sudden decrease in oxygen supply to the foetus. Without an emergency (red code) caesarean section it leads to foetal death.
Placenta in which there is an abnormal adherence to the uterine wall with placenta villi attached to the myometrium.
Placenta located over or near the cervical internal os
«Total» type: the internal cervical os is covered completely by placenta
«Marginal» type: the lower edge of the placenta reach the margin of the internal os
«Low-lying» type: the lower edge of the placenta does not reach the internal os
A placenta praevia is a placenta that is located partially or totally on the lower uterine segment (See the definition of this word).
Loss of 500 ml or more of blood after completion of the third stage of labor
and in the 24 hours following delivery.
Blood pressure ≥ 140/90 mm Hg after 20 weeks
AND
Proteinuria ≥ 300 mg/24 h
Blood pressure is 140 /90 mm Hg or greater
AND
Hypertension develops during pregnancy (after 20 weeks) and regresses post-partum
A Pregnancy of Unknown Location is a pregnancy where MDs do not know wether the pregnancy is an ectopic pregnancy or an intra uterine pregnancy.
This situation happens often when a woman has a serum hCG level below the Kadar threshold (look for the definition of Kadar threshold).
In case of PUL the woman should be followed up until the final pregnancy location is known either ectopic or intra utérine.
Often the follow up will be serial Transvaginal sonography and serial serum hCG level every 48 hours.
Infants born after 22 weeks and before 37 weeks
(+/- weighing at least 500 gr)
Is defined when the 3 following criteria are present :
-regular and painful uterine contractions
AND
-change in the cervix (dilation and or shortening)
AND
-after 20 weeks and before 37 weeks
Failure to reach menarche
Clinically diagnosed when there is no history of menstruation by the age of 15 years.
Absence of three or more periods by someone who has had periods in the past
Onset: woman reached full dilation of cervix (10 cm)
End: infant delivery
In the presence of pre-eclampsia when at least one of following criteria is present :
See Transformation Zone definition
It is an intramuscular injection of dexamethasone 5mg every 12 hours for a total of 20mg.
Crowley metaanalysis published in 1995 showed that corticosteroids reduced neonatal mortality and respiratory distress by fifty percent.
This steroïd antenatal therapy is indicated for woman at risk of preterm birth between 24 and 34 weeks.
It is an analogue of prostaglandin E2.
It is a second line, key treatment, for post partum hemorrhage in case of ocytocin failure.
Contra indications should first be eliminated in particular cardio vascular diseases.
Maximum infusion rate should be strictly followed.
Efficiency should be reached within the first 30 minutes of IV infusion.
This treatment requires a close permanent full supervision by a team of senior obstetrician and anesthesiologist.
Contraction frequency greater than five in ten minutes over a 30 minute window.
(Reference : Uterine Hyperstimulation The need for standard terminology. P Curtis, S Evens, J Resnick. J Reprod Med 1987; 32(2):91-95.)
It is a five pointed star that represent the five key elements that should be immediately implemented in a case of shoulder dystocia.
See in “Certification” chapter Question n°140 (p 337); figure n°67 (p 340) and Question n°168 (p402) and figure n°73 (p403).
Onset: infant delivery
End: delivery of the placenta and membranes
It is the part of the uterine cervix where squamous cells and glandular cells come together. It is also named “the squamocolumnar junction”.
When this zone is visible it is the line between the pink color (squamous cells) and the red color (glandular cells).
In the young woman this TZ exhibit a strong metaplasic activity and the glandular cells are progressively replaced with squamous cells.
As the woman get older this Transformation Zone enter the endocervical canal.
The cervical smear should sample cells coming from this TZ, when the TZ is within the endocervical canal an endobrush should be used.
Urine analysis with ≥ 105 bacteria / ml
Comes from “A” = without + “Tony” = tonus, it is a lack of uterine contraction.
It is a major cause of post partum hemorrhage.
It can be secondary to smooth muscle cell damage secondary to an overdistended uterus.
Overdistented uterus is likely in case of multiple fetuses, large fetus, hydramnios.
But uterine atony can occur without an overdistended uterus.
Benign uterine tumour that almost never turn into cancer
Sudden drop in blood pressure due to excessive stimulation of the vagus nerve. This can lead to paleness, excessive sweating, nausea, palpitations, vertigo, blurred vision and loss of consciousness