AAUN Obs and Gynae

03/03/2026

✨ Early Pregnancy Ultrasound Scan
• 🗓️ Gestational Age:
– Based on Last Menstrual Period (LMP)
– Confirmed by Crown-Rump Length (CRL) measurement
• 🏠 Gestational Sac (GS):
– Seen inside the uterus ✔️
– Shape: Round / Oval
– Yolk sac present? ➝ Yes / No
• 🥚 Yolk Sac:
– First structure seen inside the gestational sac
– Indicates early viable pregnancy
• 👶 Fetal Pole:
– Visible? ✔️ / ❌
– CRL measurement: ___ mm
• ❤️ Fetal Heart Activity:
– Present ✔️
– Heart Rate: ___ beats per minute (Normal: 110–160 bpm)
• 📍 Location of Pregnancy:
– Intrauterine ✔️
– Rule out ectopic pregnancy
• 🧭 Uterus & Cervix:
– Uterus size appropriate for gestation
– Cervix closed
• 🌸 Ovaries:
– Normal appearance
– Corpus luteum cyst present (common in early pregnancy)
• 💧 Free Fluid in Pelvis:
– Present / Absent
• 📊 Impression:
– Single live intrauterine pregnancy
– Corresponding to ___ weeks gestation
– Follow-up scan advised in ___ weeks

Early Pregnancy Ultrasound Scan is one of the most important investigations in obstetrics. In this video, we explain what to look for in an early pregnancy s...

02/03/2026

Choice of Antibiotics in different conditions

02/03/2026

📘 Causes of Miscarriage
🌱 1️⃣ Fetal / Chromosomal Causes (Most Common – especially 35 years)
🩺 8️⃣ Thrombophilias (Other than APS)
🔹 Inherited thrombophilia
📌 Routine testing not recommended unless history suggests
❌ 9️⃣ Unexplained Causes
🔹 In many cases, no definite cause found
📌 Especially in isolated early miscarriage
🌼 Important RCOG Notes
👉 Most single early miscarriages are due to sporadic chromosomal error
👉 Extensive investigations are recommended after recurrent miscarriage (3 consecutive losses)
👉 Emotional support and reassurance are essential

01/03/2026

🌊 Amniotic Fluid Volume Assessment on Ultrasound
🎯 Why Assess AFV?
➤ Indicator of placental function
➤ Reflects fetal renal perfusion & urine output
➤ Important in IUGR, diabetes, PROM, post-dates
📏 1️⃣ Amniotic Fluid Index (AFI)
🔹 Technique
➤ Divide uterus into 4 quadrants
➤ Use maternal umbilicus as horizontal line
➤ Measure deepest vertical pocket (DVP) in each quadrant
➤ Cord & fetal parts excluded ❌
➤ Sum of 4 pockets = AFI
🔹 Interpretation
🟢 Normal: 8–24 cm
🔵 Borderline: 5–8 cm
🔴 Oligohydramnios: ≤5 cm
🟡 Polyhydramnios: ≥25 cm
📐 2️⃣ Single Deepest Vertical Pocket (SDP / MVP)
🔹 Technique
➤ Identify largest fluid pocket
➤ Measure vertical depth only
➤ Pocket must be ≥1 cm wide
➤ No cord or limbs inside pocket
🔹 Interpretation
🟢 Normal: 2–8 cm
🔴 Oligohydramnios: 8 cm
⚖ AFI vs SDP
➤ AFI → More commonly used
➤ SDP → Preferred in low-risk pregnancies (fewer false positives)
➤ SDP preferred in multiple pregnancy
🚨 Causes of Abnormal AFV
🔴 Oligohydramnios
➤ PROM
➤ Placental insufficiency
➤ Fetal renal agenesis
➤ Post-dates
🟡 Polyhydramnios
➤ Maternal diabetes
➤ Fetal anomalies (GI obstruction)
➤ Fetal anemia
➤ Idiopathic
💡 Clinical Pearls
✔ Always scan in sagittal plane
✔ Keep probe perpendicular to floor
✔ Avoid excessive pressure
✔ Use color Doppler to exclude cord

Amniotic fluid or the liquor volume is measured by using three ultrasonographic measurements and those include subjective assessment of amniotic fluid volume...

28/02/2026

🩺 Visualization of Ovaries on Ultrasound
🌸 1️⃣ Patient Preparation
➤ Transabdominal scan (TAS) → Full urinary bladder 🟢
➤ Transvaginal scan (TVS) → Empty bladder
➤ Explain procedure & obtain consent
➤ Lithotomy position for TVS
🔎 2️⃣ Probe Selection
➤ TAS → 3–5 MHz curvilinear probe
➤ TVS → 5–9 MHz endocavitary probe (better resolution ✨)
➤ TVS preferred for small ovaries / infertility workup
📍 3️⃣ Identify Uterus First
➤ Locate uterus in sagittal plane
➤ Follow laterally toward adnexa
➤ Ovaries usually lie:
Lateral to uterus
Anterior to internal iliac vessels
Near ovarian fossa
🧭 4️⃣ Landmarks to Find O***y
➤ Internal iliac vessels (color Doppler helpful 🎯)
➤ External iliac vessels
➤ Ureter (posterior landmark)
➤ O***y often medial to vessels
🥚 5️⃣ Sonographic Appearance
➤ Almond-shaped structure 🌰
➤ Homogeneous stroma
➤ Multiple small anechoic follicles (2–9 mm)
➤ Dominant follicle if mid-cycle (≥18 mm)
📏 6️⃣ Measurements
➤ Measure in 3 planes:
Length
Width
Height
➤ Volume formula:
L \times W \times H \times 0.523
🌊 7️⃣ Tips for Difficult Ovaries
➤ Apply gentle probe pressure (TVS)
➤ Ask patient to change position
➤ Scan slowly in sweeping motion
➤ Look for “follicle cluster” pattern
➤ Postmenopausal ovaries → small & difficult to visualize
🚨 8️⃣ Common Pitfalls
➤ Mistaking bowel loops for o***y ❌
➤ Confusing paraovarian cyst with ovarian cyst
➤ Not using Doppler in suspected torsion
🎯 Quick Clinical Pearls
✔ TVS gives superior detail
✔ Always document both ovaries
✔ Compare size & follicle number
✔ In PCOS → ≥12 follicles or increased volume

In general, we can use either a sagittal or transverse view to identify the ovaries, which are usually located lateral and/or posterior to the uterus. An ova...

27/02/2026

BTL Notes
👉 Meaning
🎯 Direct marketing activities
👥 Targets a specific audience
📍 Focused & personalized promotion
💰 Lower budget than ATL
🚀 Key Features
🎯 Highly targeted
💬 Direct communication with customers
📊 Easy to measure results
💵 Cost-effective
🤝 Builds strong customer relationships
🛠️ Examples of BTL Activities
📦 In-store promotions
🏬 Trade shows & exhibitions
🎁 Free samples
📧 Email marketing
📱 SMS / WhatsApp marketing
🎪 Event sponsorship
🏢 Direct selling
📰 Brochures & pamphlets
⚖️ BTL vs ATL (Quick Difference)
BTL
🎯 Specific audience
💵 Lower cost
📍 Direct engagement
ATL (Above The Line)
📺 TV ads
📻 Radio ads
📰 Newspaper ads
🌍 Mass audience
🌟 Advantages
✔️ Personalized marketing
✔️ Better customer interaction
✔️ High conversion rate
✔️ Immediate feedback
❌ Disadvantages
❗ Limited reach
❗ Time-consuming
❗ Needs proper planning

Bilateral Tubal Ligation (BTL ) is a procedure in which the fallopian tubes on both sides are ligated by using different techniques thereby preventing fertil...

24/02/2026

🎗️ Endometrial Cancer
🌸 What is Endometrial Cancer?
➡️ Malignancy arising from endometrial lining of the uterus
➡️ Most common gynecological cancer in developed countries
➡️ Usually diagnosed early due to abnormal bleeding
🛑Risk Factors
✨ Unopposed Estrogen exposure
Early menarche
Late menopause
Nulliparity
PCOS
Estrogen-only HRT
✨ Metabolic factors
Obesity (most important risk factor ⚠️)
Diabetes
Hypertension
✨ Others
Tamoxifen therapy
Lynch syndrome (HNPCC)
Family history
🧬 Types (Pathological Classification)
🌿 Type I (Endometrioid) – 80%
➡️ Estrogen-dependent
➡️ Associated with hyperplasia
➡️ Better prognosis
➡️ PTEN mutation common
🔥 Type II (Non-endometrioid)
➡️ Serous / Clear cell
➡️ Estrogen-independent
➡️ Elderly, thin women
➡️ p53 mutation
➡️ Aggressive & poor prognosis
🚨 Clinical Features
➡️ Postmenopausal bleeding (MOST common ⚠️)
➡️ Intermenstrual bleeding
➡️ Watery or blood-stained discharge
➡️ Pelvic pain (late sign)
🔬 Diagnosis
✨ First step → Transvaginal ultrasound (TVS)
Endometrial thickness > 4 mm (postmenopause) → suspicious
✨ Gold standard → Endometrial biopsy
✨ Further evaluation
Hysteroscopy
MRI pelvis (staging)
📊 Staging (FIGO – Surgical)
🌼 Stage I → Confined to uterus
🌼 Stage II → Cervical stromal involvement
🌼 Stage III → Local/regional spread
🌼 Stage IV → Bladder / bowel / distant metastasis
🏥 Management
✨ Mainstay = Surgery ➡️ Total abdominal hysterectomy (TAH)
➡️ Bilateral salpingo-oophorectomy (BSO)
➡️ ± Lymph node dissection
✨ Adjuvant therapy
Radiotherapy
Chemotherapy (advanced cases)
Hormonal therapy (progesterone in selected cases)
🧪 Screening
❌ No routine screening
✔️ High suspicion in postmenopausal bleeding
🌟 Prognosis
➡️ Generally good (if detected early)
➡️ 5-year survival Stage I ≈ 80–90%

Endometrial cancer is a common gynaecological malignancy arising from the uterine lining, most often presenting with postmenopausal bleeding. Prognosis depen...

22/02/2026

📏Fetal Measurements
🗓️1️⃣First Trimester(6–13weeks)
🔹Crown–Rump Length(CRL)
➤Most accurate for dating(±3–5days)
➤Measured in mid-sagittal plane
➤Neutral fetal position(not flexed/hyperextended)
➤From crown of head to rump(exclude yolk sac & limbs)
🔹Mean Sac Diameter(MSD)
➤Early pregnancy dating(before embryo visible)
➤Average of 3 orthogonal sac measurements
🔹Nuchal Translucency(NT)(11–13+6weeks)
➤Mid-sagittal view
➤Associated with aneuploidy & cardiac defects
📐2️⃣Second&Third Trimester Measurements
🧠Biparietal Diameter(BPD)
🔹Outer–inner skull measurement
🔹Taken at level of:
➤Thalami
➤Cavum septi pellucidi
🔹Avoid too low(cerebellum)or too high(ventricles)
🔹Used for GA & growth monitoring
🟢Head Circumference(HC)
🔹Elliptical measurement
🔹Same plane as BPD
🔹More reliable in abnormal head shapes
🔹Important in microcephaly/macrocephaly
🟡Abdominal Circumference(AC)
🔹Transverse view at:
➤Stomach bubble
➤Portal sinus(hockey stick sign)
🔹Most sensitive parameter for IUGR
🔹Reflects fetal nutrition & liver size
🦴Femur Length(FL)
🔹Measure ossified diaphysis only
🔹Exclude epiphysis
🔹Longest bone visible
🔹Useful in skeletal dysplasia screening
⚖️Estimated Fetal Weight(EFW)
🔹Calculated using:
➤BPD/HC
➤AC
➤FL
🔹Hadlock formula commonly used
🔹Error margin±10%
📊Growth Assessment
🔹Plot on gestational age chart
🔹Compare percentiles:
➤90th→LGA
🔹Serial scans 2–4weeks apart

Fetal Measurements by using different ultrasound parameters is called Fetal Biometry. It is done by using measuring bi parietal diameter, the head circumfere...

21/02/2026

🚨MATERNAL RESUSCITATION
🔴 💥 First Things First: CALL FOR HELP!
🚨 Activate Code Blue
Obstetrician + Anesthetist + Neonatology team
⏱️ Note time of arrest
🫁 A – AIRWAY
Check responsiveness
Open airway (Head tilt–chin lift / Jaw thrust)
🫁 Early endotracheal intubation preferred
⚠️ Anticipate:
Airway edema
Rapid desaturation
Difficult intubation
🌬️ B – BREATHING
💨 100% Oxygen
🎯 Target SpO₂ > 94%
🫁 Ventilate with bag–mask if needed
⚡ Avoid hyperventilation
❤️ C – CIRCULATION (MODIFIED CPR)
👐 Chest compressions:
Rate: 100–120/min
Depth: 5–6 cm
Minimal interruptions
📍 Hand position:
Slightly higher on sternum (due to gravid uterus)
🔄 Ratio:
30:2 (if no advanced airway)
Continuous compressions (if intubated)
↩️ LEFT UTERINE DISPLACEMENT (VERY IMPORTANT!)
🤲 Manual displacement of uterus to left
🎯 Reduces aortocaval compression
❌ Do NOT tilt whole patient
🛏️ Keep patient supine on firm surface
💉 D – DRUGS
💊 Adrenaline 1 mg IV every 3–5 minutes
🔌 Secure 2 large-bore IV lines
💧 Aggressive fluid resuscitation
🧪 Send labs (ABG, CBC, coagulation)
⚡ DEFIBRILLATION
⚡ Same energy levels as non-pregnant
❌ Do NOT remove fetal monitor before shock
🔄 Continue CPR immediately after shock
⏱️ 4–5 MINUTE RULE (PERIMORTEM CESAREAN)
⏳ If no ROSC within 4 minutes
🔪 Start Resuscitative Cesarean Delivery
🎯 Aim delivery by 5 minutes
Benefits:
Improves maternal circulation
Improves fetal survival
🔍 Reversible Causes (4 Hs & 4 Ts)
🩸 Hs
Hypoxia
Hypovolemia
Hypo/Hyperkalemia
Hypothermia
💥 Ts
Tension pneumothorax
Tamponade
Toxins
Thromboembolism (PE / Amniotic fluid embolism)
👶 Fetal Considerations
🫀 Continuous fetal monitoring (if viable gestation)
🗣️ Neonatal team ready for resuscitation
🧠 Post-ROSC Care
🩺 ICU admission
📊 Maintain MAP > 65 mmHg
🌡️ Temperature control
🧠 Neurological assessment
👶 Ongoing fetal monitoring
✨ KEY POINTS TO REMEMBER
Prioritize maternal life first
↩️ Manual uterine displacement is crucial
⏱️ Think of cesarean by 4 minutes
👥 Multidisciplinary team approach

Knowledge about the steps of Maternal Resuscitation is very important for all doctors. Like any other emergency the first step is call for help and to ensure...

20/02/2026

🩺 Hysterosalpingography (HSG)
🌸 What is HSG?
➤ X-ray procedure to evaluate uterine cavity + fallopian tube patency
➤ Contrast dye injected via cervix
➤ Performed under fluoroscopy
🖼️ Normal HSG Appearance
➤ 🟢 Triangular uterine cavity
➤ 🟢 Smooth regular margins
➤ 🟢 Thin fallopian tubes
➤ 🟢 Free bilateral peritoneal spill
📅 Timing of HSG
➤ 🗓️ Day 7–10 of menstrual cycle
➤ After menstruation
➤ Before ovulation
➤ Ensure not pregnant
🎯 Indications
➤ 🔹 Infertility workup
➤ 🔹 Recurrent miscarriage
➤ 🔹 Suspected tubal block
➤ 🔹 Congenital uterine anomalies
➤ 🔹 Post-tubal surgery evaluation
⚙️ Procedure Steps
➤ Position patient in lithotomy
➤ Insert speculum → clean cervix
➤ Cannula placed in cervical os
➤ Inject radio-opaque contrast
➤ Serial X-ray images taken
🚫 Contraindications
➤ ❌ Pregnancy
➤ ❌ Active pelvic infection
➤ ❌ Heavy uterine bleeding
➤ ❌ Recent uterine perforation
⚠️ Complications
➤ 🔸 Pelvic infection
➤ 🔸 Pain / cramping
➤ 🔸 Vasovagal attack
➤ 🔸 Allergic reaction to contrast
➤ 🔸 Rare uterine perforation
🔎 Abnormal Findings
➤ 🔴 Cornual block
➤ 🔴 Hydrosalpinx
➤ 🔴 Beaded tubes (TB)
➤ 🔴 Filling defects (polyps, fibroids)
➤ 🔴 Septate / bicornuate uterus
📊 Advantages
➤ ✔️ Simple & outpatient
➤ ✔️ Cheap
➤ ✔️ Can improve fertility (tubal flushing effect)
❗ Limitations
➤ ✖ Radiation exposure
➤ ✖ Cannot assess external uterine contour (vs 3D USG/MRI)
➤ ✖ False positive tubal spasm
📝 Clinical Pearls
➤ First-line test for tubal patency
➤ Differentiate septate vs bicornuate → need 3D USG/MRI
➤ Prophylactic antibiotics in high-risk patients

HSG or Hysterosalpingography, also known as uterosalpingography, is a radiologic procedure to investigate the shape of the uterine cavity and the shape and p...

16/02/2026

Birth After Previous Caesarean Birth (VBAC) /RCOG
In this video, we discuss Birth After Previous Caesarean Birth (VBAC) according to the latest RCOG Guideline.
You will learn:
✔ What is VBAC and who is eligible
✔ Indications and contraindications for VBAC
✔ Success rates and benefits of VBAC
✔ Risks including uterine rupture
✔ Counseling points for women with previous C-section
✔ Intrapartum management and monitoring
✔ When to plan repeat caesarean section
This video is especially useful for:
🔹 FCPS, MRCOG, PLAB & MBBS students
🔹 Obstetrics & Gynaecology trainees
🔹 Practicing doctors and midwives
All information is explained in a clear, exam-oriented and evidence-based manner following Royal College of Obstetricians and Gynaecologists (RCOG) recommendations.
📢 Subscribe to AAUN Obs and Gynae for high-yield obstetrics & gynaecology concepts, guidelines, ultrasound tips, and exam-focused content.
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In this video, we discuss Birth After Previous Caesarean Birth (VBAC) according to the latest RCOG Guideline.You will learn:✔ What is VBAC and who is eligibl...

16/02/2026

Tablet Clomiphene Citrate (Clomid)

In Females, Clomiphene Citrate is commonly indicated to treat patients diagnosed with anovulatory or oligo-ovulatory infertility for Ovulation induction and ...