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Adnexal torsion is twisting of the ovary and sometimes the fallopian tube, interrupting the arterial supply and causing ischemia. The symptoms of a twisted ovary arise suddenly and intensely. They include severe pain in the pelvic region (lower abdominal pains), as well as nausea and vomiting. The sudden pain is often preceded by occasional cramps for several days, or sometimes, for weeks (often because the ovary twists and untwists repeatedly).

Common pregnancy complications of the mother with SCD include: miscarriages, frequent vaso-occlusive crises, severe anaemia, recurrent UTIs, acute chest syndrome, preterm labour and pulmonary embolism. However, the most common is vaso-occlusive crisis. Fetal complications include; intrauterine growth restriction, prematurity and intrauterine fetal death.

First trimester ultrasound examination is done to evaluate the presence, size and location of the pregnancy, determine the number of fetuses, and estimate gestational age. Ultrasound can also be used for first trimester genetic screening (chromosomal anomalies), as well as screening for abnormalities of the uterus or cervix. In the second or third trimester a standard ultrasound is done to evaluate several features of the pregnancy, including fetal anatomy (congenital anomalies). This exam is typically done between weeks 18 and 20 of pregnancy. However, the timing of this ultrasound might be altered for reasons such as obesity, which could limit visualization of the fetus.

TORCH syndrome is a cluster of symptoms caused by congenital infection with TOXOPLASMOSIS (T), RUBELLA (R), CYTOMEGALOVIRUS (C), HERPES SIMPLEX (H), and OTHER (O) organisms including syphilis, parvovirus, and Varicella zoster.

Operative vaginal delivery refers to a delivery in which the operator uses forceps, a vacuum, or other devices to extract the fetus from the vagina, with or without the assistance of maternal pushing. The two most common indications or pre-requisite for operative vaginal delivery are prolonged second stage of labor (the 'pushing' phase) and a concerning fetal heart tracing. Others include Maternal exhaustion, intracranial pathologies, congenital heart diseases, severe hypertension (eclampsia) and significant antepartum haemorrhage. However, contraindicated in preterm, breech presentation, true cephalo-pelvic disproportion, unengaged fetal head and prolapse of the umbilical cord with fetal compromise when the cervix is completely dilated and the station is mid cavity.

The external iliac artery supplies the lower limb, and the internal iliac artery is the major vascular supply of the pelvis. Internal iliac artery is divided into anterior and posterior trunk. The anterior trunk supplies the pelvis, visceral organs, and the posterior trunk supplies pelvic parietal structures.

Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year for most couples. Infertility may result from an issue with either the man or the woman, or a combination of factors that prevent pregnancy.

Chadwick sign is a bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow. It can be observed as early as 6 to 8 weeks after conception, and its presence is an early sign of pregnancy.

Rh sensitization can occur during pregnancy if you are Rh-negative and pregnant with a developing baby (fetus) who has Rh-positive blood. In most cases, your blood will not mix with your baby's blood until delivery. It takes a while to make antibodies that can affect the baby, so during your first pregnancy, the baby probably would not be affected. But if you get pregnant again with an Rh-positive baby, the antibodies already in your blood could attack the baby's red blood cells. This can cause the baby to have anemia, jaundice, or more serious problems like miscarrgaes, APH and even ectopic pregnancy. This is called Rh disease. The problems will tend to get worse with each Rh-positive pregnancy you have. Epistasis (nosebleeds) in pregnancy is even common during normal pregnancy because pregnancy can make the blood vessels in the nose expand, and the increased blood supply puts more pressure on those delicate vessels, causing them to rupture more easily.

The m?llerian ducts are the primordial anlage of the female reproductive tract. They differentiate to form the fallopian tubes, uterus, the uterine cervix, and the superior aspect of the vagina. These are the upper portion of the vagina.

Fetal macrosomia is a condition in which a fetus is larger than average (between 4,000 grams [8 pounds, 13 ounces] and 4,500 grams [9 pounds, 15 ounces]). There are many causes, including diabetes or obesity in the mother and advanced maternal age. While fetal macrosomia is unpredictable, promoting good health and a healthy pregnancy can help prevent it. Factors associated with fetal macrosomia include genetics; duration of gestation; presence of gestational diabetes; high pre-pregnancy body mass index (BMI); excessive gestational weight gain; and gestational diabetes mellitus. The off option here is therefore maternal.

Vertical transmission (VT) of HIV is defined as that occurring from mother to child during gestation, delivery, or breastfeeding. There is a lower risk of infection among babies born by caesarean section than those delivered vaginally in both the in utero and intra-partum groups. Prolonged rupture of membranes before delivery increases risks in intra-partum infection. Low CD4 cell count reduces the risk of transmission. However, high viral load has been reported to increase risk of HIV transmission.

The partograph is a tool for monitoring maternal and foetal wellbeing during the active phase of labour, and a decision-making aid when abnormalities are detected. Its central feature is a graph used to record the progress of cervical dilation, as determined by vaginal examination. Start the graph at 5 cm of dilation, and 3 contractions every 10 minutes. In certain situations, e.g. induction of labour, it is started at 4 cm of dilation.

The primary colonizing bacteria in the vagina of a healthy individual are of the genus Lactobacillus.

CT can identify an underlying ovarian mass which serves as a lead point for torsion. However, not all ovaries with a mass in patients with acute pelvic pain are torted. Hence, other supportive clinical or imaging features are required to establish the diagnosis of torsion. Ultrasound is the diagnostic modality of choice for detecting torsion. The absence of blood flow within the ovary on Doppler exam is a highly specific finding but the presence of Doppler flow does not exclude the diagnosis of torsion.

Bacterial vaginosis (BV) is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina. Symptoms are: Thin, gray, white or green vaginal discharge, Foul-smelling "fishy" vaginal odor, Vaginal itching and Burning during urination.

Molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus and will fail to come to term. A molar pregnancy is a gestational trophoblastic disease which grows into a mass in the uterus that has swollen chorionic villi. These villi grow in clusters that resemble grapes. They are categorized as partial moles or complete moles. In a complete molar pregnancy, the placental tissue is abnormal and swollen and appears to form fluid-filled cysts. There is also no formation of fetal tissue. In a partial molar pregnancy, there may be normal placental tissue along with abnormally forming placental tissue.

In nonpregnant women, asymptomatic bacteriuria (ASB) rarely causes serious problems. However, in pregnant women this infection can progress upward, causing acute urethritis, acute cystitis, and acute pyelonephritis.

The uterus is primarily supported by the pelvic diaphragm, perineal body, and urogenital diaphragm. Secondarily, it is supported by ligaments, including the peritoneal ligament and the broad ligament of uterus. The pelvic fasciae consist of two components: (i) the endopelvic fascia, which primarily covers the pelvic muscles; and (ii) the visceral fascia which covers the pelvic organs and the supplying vessels and nerves.1-3 Together, they support and define the structures in the pelvis including the uterus.

The four different pelvis shapes are: Gynecoid, Android, Platypelloid and Anthropoid. The gynecoid pelvis is thought to be the most favorable pelvis type for a vaginal birth. This is because the wide, open shape give the baby plenty of room during delivery. Android - This type of pelvis bears more resemblance to the male pelvis. It's narrower than the gynecoid pelvis and is shaped more like a heart or a wedge. Anthropoid - An anthropoid pelvis is narrow and deep. Its shape is similar to an upright egg or oval. Platypelloid - The platypelloid pelvis is also called a flat pelvis. This is the least common type. It is wide but shallow, and it resembles an egg or oval lying on its side.

Postpartum psychosis is a rare but serious mental health illness that can affect a woman soon after she has a baby. Many women will experience mild mood changes after having a baby, known as the "baby blues". This is normal and usually only lasts for a few days. Common pregnancy complications of the mother with SCD include: miscarriages, frequent vaso-occlusive crises, severe anaemia, recurrent UTIs, acute chest syndrome, preterm labour and pulmonary embolism. However, the most common is vaso-occlusive crisis. Fetal complications include; intrauterine growth restriction, prematurity and intrauterine fetal death.

Increased exposure to microorganisms undoubtedly will lead to increased risk of urinary tract infection.

Normal puberty in girls can start as early as 8 years old and as late as 13 years old. When the ovaries start creating estrogen, this results in the breast tissues gaining fat. This additional fat causes the breasts to begin to grown larger. This is also when the milk ducts grow.

Most women will lose less than 16 teaspoons of blood (80ml) during their period, with the average being around 6 to 8 teaspoons. Heavy menstrual bleeding is defined as losing 80ml or more in each period, having periods that last longer than 7 days, or both.

The fetal heart rate tracing shows ALL of the following: Baseline FHR 110-160 BPM, moderate FHR variability, accelerations may be present or absent, NO LATE OR VARIABLE DECELERATIONS, may have early decelerations. Tachycardia, bradycardia without absent variability.

The contraindications for induction are the same as the contraindications for a vaginal delivery. Examples include, vasa previa, placenta previa, myomectomy with entry into uterine cavity, previous classical hysterotomy, active genital herpes outbreak, umbilical cord prolapse, or transverse fetal lie.

By about the fifth month of fetal development, the ovaries contain about seven million oogonia. Over the next few months, oogonia undergo mitosis, forming cells called primary oocytes. Primary oocytes are also diploid cells. AT BIRTH, THE AVERAGE FEMALE HAS ABOUT TWO MILLION PRIMARY OOCYTES IN HER OVARIES. Throughout childhood, the number of oocytes falls as they deteriorate and disappear. By puberty, there are only about 300,000 to 400,000 primary oocytes left in the average girl's ovaries.

Anemia in pregnancy is defined as a hemoglobin concentration of less than 110 g/L (less than 11 g/dL) in venous blood according to WHO.

Ovarian cancer mainly affects women who have been through the menopause (usually over the age of 50), but it can sometimes affect younger women. Other risk factors include family history, hormone replacement therapy, history of breast cancer, obesity and overweight.

Endometrial hyperplasia thickens the uterus lining, causing heavy or abnormal bleeding. Atypical endometrial hyperplasia raises the risk of endometrial cancer and uterine cancer. The condition tends to occur during or after menopause. Endometrial hyperplasia is more likely to occur in women with the following risk factors: Age older than 35 years, White race, never having been pregnant, Older age at menopause, Early age when menstruation started, Personal history of certain conditions, such as diabetes mellitus, polycystic ovary syndrome, gallbladder disease, or thyroid disease, Obesity, Cigarette smoking and Family history of ovarian, colon, or uterine cancer.

Perinatal: Pertaining to the period immediately before and after birth. Depending on the definition, it starts at the 20th to 28th week of gestation and ends 1 to 4 weeks after birth. Preterm birth is the most common cause of perinatal mortality, causing almost 30 percent of neonatal deaths. Infant respiratory distress syndrome, in turn, is the leading cause of death in preterm infants, affecting about 1% of newborn infants. Birth defects cause about 21 percent of neonatal death.

Lactation amenorrhea method (LAM) is a way for breastfeeding to temporarily help prevent pregnancy. It must be used correctly to work. Therefore, the woman must be less than six months postpartum, breastfeeding exclusively and amenorrheic

Cervical cerclage, also known as a cervical stitch, is a treatment for cervical weakness or insufficiency, when the cervix starts to shorten and open too early during a pregnancy causing either a late miscarriage or preterm birth.

Oral iron supplements can cause the following side effects: Dark stools, upset stomach, Constipation (you may need to take a stool softener), Heartburn and Nausea. It does not usually lead to GI bleeding.

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas or myomas. Uterine fibroids are not associated with an increased risk of uterine cancer and almost never develop into cancer. Many women have uterine fibroids sometime during their lives. But you might not know you have uterine fibroids because they often cause no symptoms and hence may require no treatment. In those that do, symptoms can be influenced by the location, size and number of fibroids which will also require treatment.

A Bonney test is done as part of the bladder stress test, after the doctor verifies that urine is lost with coughing. It is similar to the bladder stress test except the bladder neck is lifted slightly with a finger or instrument inserted into the vagina while the bladder stress is applied. Stress incontinence happens when physical movement or activity - such as coughing, laughing, sneezing, running or heavy lifting - puts pressure (stress) on the bladder, causing it to leak urine.

Retention of the second twin is diagnosed if the twin is still undelivered 30 minutes after the birth of the first baby and this condition constitutes an obstetric emergency often associated with a poor outcome. The main causes or risks of retention are uterine inertia, malpresentation and home delivery of the first twin. Other factors include umbilical cord prolapse (dropping into the cervix opening) and operative delivery.

Antepartum haemorrhage (APH) is defined as any bleeding from the genital tract between the 28th week of pregnancy and the onset of labour

Operative vaginal delivery refers to a delivery in which the operator uses forceps, a vacuum, or other devices to extract the fetus from the vagina, with or without the assistance of maternal pushing. The two most common indications or pre-requisite for operative vaginal delivery are prolonged second stage of labor (the 'pushing' phase) and a concerning fetal heart tracing. In this case, willingness to abandon procedure (push) due to tiredness of the woman.

Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. Adrenarche begins on average between age 5 to 8 years, and precedes puberty by about 2 years. Unlike the physical changes that occur during puberty, adrenarche is primarily an emotional and psychological stage of development. It continues throughout puberty, with adrenal androgen levels progressively increasing until reaching maximal levels in young adulthood, around the age of 20 years.

Clue cells are epithelial cells of the vagina that are a medical sign of bacterial vaginosis, particularly that caused by Gardnerellavaginalis, a group of Gram-variable bacteria. This bacterial infection is characterized by a foul, fishy smelling, thin gray vaginal discharge, and an increase in vaginal pH from around 4.5 to over 5.5.

The primary colonizing bacteria in the vagina of a healthy individual are of the genus Lactobacillus.

If you are Rh-negative, your red blood cells do not have a marker called Rh factor on them. Rh-positive blood does have this marker. If your blood mixes with Rh-positive blood, your immune system will react to the Rh factor by making antibodies to destroy it. This immune system response is called Rh sensitization. To prevent this Rh sensitization, non-sensitized rhesus negative mothers require anti - D globulin antenatally and immediate post-delivery. Rh sensitization during pregnancy can only happen if a woman has Rh-negative blood and only if her baby has Rh-positive blood.

The 'LH' surge causes the release of the mature egg from the ovary - this is ovulation. Ovulation normally occurs 24 to 36 hours after the LH surge, which is why the LH surge is a good predictor of peak fertility.

The risk of developing ovarian cancer gets higher with age. Ovarian cancer is rare in women younger than 40. Most ovarian cancers develop after menopause. Half of all ovarian cancers are found in women 63 years of age or older. Obesity has been linked to a higher risk of developing many cancers. Others include hormone therapy replacement, infertility, PCOS, endometriosis, family history among many others but tubal ligation.

Physiological adaptation in pregnancy leads to physiological anemia of pregnancy. This is because the plasma volume expansion is greater than red blood cell (RBC) mass increase which causes hemodilution. Normal pregnancy increases iron requirement by 2-3 fold and folate requirement by 10-20 fold. This usually begins during the second trimester.

Pregnant teenagers (adolescent) face many of the same pregnancy related issues as other women. There are additional concerns for those under the age of 15 as they are less likely to be physically developed to sustain a healthy pregnancy or to give birth. For girls aged 15-19, risks are associated more with socioeconomic factors than with the biological effects of age. Risks of low birth weight, premature labor, ANEMIA, and pre-eclampsia are connected to biological age, being observed in teen births even after controlling for other risk factors (such as accessing prenatal care etc.).

Secondary infertility is the inability to become pregnant or to carry a baby to term after previously giving birth to a baby. Secondary infertility shares many of the same causes of primary infertility and its prevalence is about six time primary infertility. Paternal age of greater than 40 years was found to be a risk factor for infertility in women age 35 years or more. Smoking can also have a negative impact on sperm quality and this is common in heavy smokers (20 cigarettes a day).

Semen quality is a measure of male fertility, a measure of the ability of sperm in semen to accomplish fertilization. Semen quality involves both sperm quantity and quality. One of the factors affecting semen quality is abstinence time, or the time between ejaculatory events. The World Health Organization (WHO) recommends that for testing and analysis, semen samples should be collected after a minimum of 2 days and a maximum of 7 days of sexual abstinence.

The body iron requirement for an average pregnancy is approximately 1,000 mg (1g). Hallberg (1988) calculated that 350 mg of iron is lost to the fetus and the placenta and 250 mg is lost in blood at delivery. In addition, about 450 mg of iron is required for the large increase in maternal red blood cell mass.