NBE CME programme for DNB consultants - National Board Of ...

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NBE CME programme for DNB consultantsConsumer protection Act Imp. Of consent and counselingFamily planning- Condom; I.U.C.D. – Cu-T, Cu-7, Cu-350, Multi load; Lippes loop; Oral pills -MalaD, Mala N, Saheli, Lynoral; Injection Depoprovera; Today; Cervical Cap; Laproscopic rings9laproscopii set);Students should know - Various types of contraceptive device – indication/contraindication; MTP – Act, Procedure, Complication, Contraceptive quidence; Faliure rates ofvarious contraceptives – Sterlisation- Female- Tubal ligation, Prmsoy’s/ Laps, Couple protectionrate, Fertility Rate- Total population- Vasectomy, Contraceptive prevalence, Failure rates of variousmethods & legal implicationsGynaec- Specimen - Fibroid uterus, Cancer cervix, Vascular Mole, Ectopic pregancny, Adenomyosis,Cervical fibroid, Cancer Endometorium, Ovarian cystX-ray – Hysterosalpingography, Breech presentation, Twins/ Multiple pregnancy, Anencephaly,Hydrocephaly, Conjoined Twins; U/S - Vascular moleStudents should know - Minor operation – Dilatation & curretlage, E.B., Cervical Dilatation, CervicalBiopsy – Type, Fraction curettage, Pap smear/ Colposcopy, Vulvar biopsy, Wet smear; Majoroperations - Various types abdominal incision, opening & closing of abdomen wound, Types ofhysterectomy – Indications, Route; Ovarian Cystectomy; Oviriotomy; Salpigo-opherectomy;Salpingotomy – Partial/ total; Operation for - Cervical Malignancy, Uterine Malignancy OvarianMalignancy, Vulval Malignancy ; Chemotherapy in gynaec malignancyBad obstetrical historyHistory- Age of the patient at conception, education status of husband and wife; Husband’soccupation; Last Menstrual period; Period of gestationPresenting complaints- Bleeding per vaginum; Gestational age at the time of its occurrence;Amount of bleed, ( fresh , old, clloted blood); Any passage of clots, products of conception or grapelike vesicles pain abdomen; Nature of pain and duration; History of any intercourse or trauma;Syncopial attacks; Duration and recurrence of bleeding; History of nausea and vomiting or itssudden cessation; H/o of fever with rash or genital ulcers; H/o urinary frequency, urgency or dysuria;H/o UPT done or documentation of USG examination and appearance of cardiac activity.Eig2 nd trimester pregnancy - Period of gestation; H/o quickening; H/o pelvic pressure; H/o bleedingP/V or leaking P/v; H/o recurrent lower abdominal pain; History suggestive & thyroid disorder(constipation, w ht gain, heat and cold intolerance); History S/o diabetes mellitus (polyuria,polyphagia, polydypsia); History S/o APLA (arterial or venous thrombosis, swelling of limbs, transientischaemic attack); H/o S/o cardiac disease (breathlessness, palpitation, chest pain, swelling offeet)Abnormal uterine bleedingHistory - Age; obstetric history pertaining to abortions, ectopic, gestational trophoblastic disease,last child birth, any complication causing endometritis; MENSTRUAL HISTORY – excessive bleeding,content ( clots or POCs), amount, cydical / acyclical, post – coital or intermenstrual; H/O D&C orinstrumentation; H/O Hormonal Contraception or irregular use of hormonal preparations, IUCDs;H/O sexually transmitted diseases; H/O bleeding menstrual history - Age of menarche; Regularityof the cycles; History of prolonged cycles, duration of flow, amount of bleeding; Passage of clots;History s/o dysmenorrhealObstetric history - Age at marriage and first conception; History regarding early fetal losses;Gestational age at fetal loss; History of blighted ovum (UPT + USG documentation); Pattern ofexpulsion; Any pain abdomen and bleeding PV; Any operative intervention (D & C procedure)2 ND trimester foetal losses - Any history of bleeding or leaking per vaginum and pain abdomen;Duration of expulsion of foetus; Any bleeding P/v; Pattern of fetal ( with increasing or decreasinggestational age of the losses); Any congenital abnormality in the fetus; H/o IUGR; Early PIH orfeature suggestive of arteriovenous thrombosis74
NBE CME programme for DNB consultantsPast history of thyroid disorder - Obesity, DM, HT(hypertension), Hyperprolactinemia (galactorrhoea),Cardiac, renal or hematological illness, H/o any surgery or trauma to the cervix, History s/oleiomyoma, adenomyosis PCOD ( treatment taken for infertility), History s/o autoimmune disease(fever, joint and muscular pain)Family history- DM, Hypertension, Recurrent pregnancy loss, Congenital and chromosomal defectsin the babiesPersonal history of- Cigarette smoking, Drug abuse, Alcohol intakeExamination specific to recurrent pregnancy loss - Height, Weight, BMI, Hirsutism, Acanthosis,Body habitus, Pulse, BP, Thyroid examination, Breast examination (for sign of pregnancy)Per abdominal (2 nd trimester pregnancy) - Uterine fundal height, Estimated baby weight,Presentation, Liquor volume, Fetal heart soundPer speculum - Cervix (blue or not), Length of the cervix, Internal os open or closed, Bleeding orproduct of conception coming through osPer vaginum - os closed or open, funneling of the cervix, cervical length, Uterine size correspondingto POG or not, Adnexal mass and tenderness.Investigations - Blood group+ Rh typing, Complete blood cont ( haemoglobin with platelet count),Blood sugar (fasting and postprandial), VDRL, TORCH, Lateral vaginal wall smear ( to rule outprogesterone deficiency)USG examination for- Foetal biometry, GCA, Liquor volume, Placental localization, Congenitalmalformation of uterus, associated fibroid, Cervical length/dilataion of funneling cervix coning ofthe membrane, Parental peripheral karyotyping, ACA, LAC, ANA levels, Fetal karyotyping by CVS ( ifindicated)Management - Management of etiology found if any; Management of current pregnancy - Completebed rest during the critical period, Diet, Folic acid supplementation, Luteal phase support, Heginjection ( 1500-5000iu biweekly following LH surge for 8 weeks), Inj. Proulation depot 500mg i/mweekly till 14 weeks, Natural micronized progesterone by oral and vaginal route, 100-200mg BD till14 weeks, Symptomatic treatment of nausea and vomiting, Reassurance to the patient; Treatmentof etiological factors - Syphilis, toxoplasmosis, thyroid disorder, disbetes mellitus, Immunotherapy(APLA syndrome ) from 5 weeks of pregnancy, Low dose aspirin – 80mg daily, Heparin 10000 IU s/c BD, Prednisolone 40mg to 80mg OD, Other trials regarding immunomodulation are going on,Limitation of physical activity during critical peiodPreterm labourHistory - Age of the patient at the time of conception; Education status and occupation of the patientand socioeconomic status; Period of gestationPresenting complaints - H/o pain abdomen, nature and severity of pain, duraiotn; Whether painassociated with hardening of uterus; H/o any urinary frequency or urgency, burning; H/o fever; H/othyroid disorder/PIH/heart diseaseTreatment history - 1 st trimester - exact last menstrual period and UPT, USG confirmation for exactdating, H/o fever/rash/drug exposure; 2 nd trimester - H/o of quickening, H/o of leading p/v dischargep/v, bleeding p/v or pain abdomen, H/o early onset PIHMenstrual history - Menarche, LMP, Regularity of cyclesObstetrics history-Duration of marriage; H/o any treatement taken for infertility; H/o previous pretermbirth; H/o any D & C done in past; H/o any surgery done on the cervix or any encirclage proceduredone in the past; Sequence of events of pregnancy loss – leaking P/v, Bleeding P/v, abdominal pain;Any significant postpartum events ( H/o puerperal sepsis/fever or foul smelling discharge); Pasthistory of DM/jaundice, asthma, thyroid disease any surgery done on cervix75
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