Contraception

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Obstetricians and gynecologists now have a new guide that rates the safety of different contraceptives on a scale of 1 to 4 based on an individual woman’s health status, age, and preexisting medical conditions. The new guide was issued by The American College of Obstetricians and Gynecologists (The College) and is based on the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010.

Classification of Heart Diseases in Pregnancy: Incidence: 1% of all pregnancies 1-Rheumatic valve diseases (still the most common in the developing countries.) MS, MR, DM, AS, AR. 2-Congenital disorders (The most common in developed countries.) ASD, VSD, PDA, coarcitation of the aorta, Fallot's tetralogy, Eisenminger syndrome and Marfan syndrome. 3-Others: Arrhythmias, ischemic heart disease and cardiomyopathy.

New guidelines from the American College of Obstetricians and Gynecologists contain recommendations to help prevent, manage and treat blood clots in pregnant women. Blood clots are a leading cause of maternal morbidity, with pregnancy associated with a four-fold increase in the risk of thromboembolism. As such, ACOG released “Thromboembolism in Pregnancy” in the September 2011 issue of Obstetrics & Gynecology to guide clinicians in the prevention, management and treatment of blood clots during pregnancy.

Accurate diagnosis of uterine fibroids is essential in deciding if treatment is necessary, and planning appropriate treatment.n While a physical exam may suggest fibroids, other conditions such as ovarian cysts or adenomyosis may be mistaken for fibroids. For this reason, I routinely do an ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if I feel an abnormality on examination.

Hirsutism

Hirsutism: • Not an increase in the number of hair follices but an alteration in their character. • An increase in the transformation of the vellus to terminal hair. • {Androgens will convert lanugo & vellus hair to terminal hair}.

Puberty

Puberty Dr. Ashraf Fouda Damietta General Hospital Puberty It is a physiological phase lasting 2 to 5 years, during which the genital organs mature. Manifestations of puberty in the female include:

DEFINE Any deviation in normal frequency, duration or amount of menstration in women of reproductive age. NORMAL MENSES Frequency: 21-35 d Duration: 3-7 d Volume: 30-80 ml

• The name of this group of diseases was changed from "venereal diseases" to "sexually transmitted diseases" or "STDs" • Now many persons call them "sexually transmitted infections" or "STIs."

Serial BSU's • -hCG Levels Double Every 48 Hrs • < 66% Rise / 48 Hrs Consistent With Ectopic • Single Determination Not Helpful • Best If Done Within Same Laboratory • Never Rules Out Ectopic

Definitions Primary amenorrheaFailure of menarche to occur when expected in relation to the onset of pubertal development. • No menarche by age 16 years with signs of pubertal development. • No onset of pubertal development by age 14 years. Secondary amenorrhea • Absence of menstruation for 3 or more months in a perviously mentruating women of reproductive age.

CLINICAL PICTURE •Vaginal Bleeding I. Speculum Examination:The vagina is full with clots, portio exophytic or shows. Carcinoma crater surface bleeding stronger after touching.II. Palpation:Often large tumor that fills the small pelvis.

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