Ob/Gyn Registry Review Notes

Gynecology

Normal Anatomy of the Pelvis

• Bony boundaries: sacrum, coccyx, innominate bones (ilium, ischium, pubic symphysis)
• Linea terminalis: Imaginary line from pubic symphysis to sacral prominence
• TRUE PELVIS: Below linea terminalis; includes bladder, small bowel, rectum, uterus, ovaries, etc.
• Musculature: 5 true pelvic muscles, pelvic diaphragm (levator ani and coccygeus)
• Uterine Ligaments: Broad ligaments, round ligaments, cardinal ligaments

Spaces

• Intraperitoneal cavities where fluid can collect
• Retropubic space: AKA space of Retzius
• Adnexa: Lower quadrants of abdomen
• Anterior CDS: AKA vesicouterine pouch
• Posterior CDS: AKA rectouterine pouch / pouch of Douglas

Uterus

• Pear-shaped, retroperitoneal organ
• Development: From fusion of Mllerian ducts
• FOUR DIVISIONS: Fundus, corpus, isthmus, cervix
• THREE LAYERS: serosa, myometrium, endometrium

Fallopian Tubes

• AKA oviducts, uterine tubes, salpinges
• 5 SEGMENTS: Interstitial, isthmus, ampulla, infundibulum
• Function: Fertilization and transportation to uterus

Ovaries

• Produce estrogen and progesterone
• Physiology: Responsive to FSH and LH

Normal Menstrual Cycle

• Phases: Follicular, Proliferative, Ovulation, Luteal, Secretory
• Hormones: FSH, LH, Estrogen, Progesterone

Clinical History and Indications

• Important to gather patient history, prior exams, medication, etc.
• Indications for Ultrasound: Pain, bleeding, anomalies, infertility, cancer risk

Common Terms

• Mittelschmertz: Pain during ovulation
• Amenorrhea: Absence of menstruation

Obstetrics

Normal First Trimester

• Embryology: Fertilization, implantation, development of gestational sac
• Key Structures: Yolk sac, amniotic cavity, chorionic cavity

Abnormal First Trimester

• Ectopic pregnancy: Pregnancy outside the central uterine cavity
• Gestational Trophoblastic Disease: Molar pregnancy
• Miscarriages: Various types, including complete, incomplete, threatened, etc.

Multiple Gestations

• Dizygotic Twins: Two separate eggs; always dichorionic/diamniotic
• Monozygotic Twins: Single egg that splits; various combinations based on time of split
• Complications: TTTS, acardiac twin, conjoined twins

Maternal Health and Fetal Environment

Placental Pathologies

• Placenta Previa: Placenta covers or is near the internal os
• Accreta, Increta, Percreta: Abnormal placental adherence
• Abruption: Premature separation of placenta

Doppler Studies

• Uterine artery, umbilical artery, MCA, DV

Amniotic Fluid and Biophysical Profile

• AFI and DVP: Measures of amniotic fluid volume
• BPP: Fetal movement, tone, breathing, amniotic fluid

Physics Review

Image Optimization

• B-mode technique: Use perpendicular imaging angle
• Transducer frequency: Choose based on depth and resolution needs

Doppler Principles

• Color and PW Doppler: To assess flow direction and velocity
• Power Doppler: For presence of flow

ALARA Principle

• Minimize exposure by adjusting settings

Trisomy and Syndromes

• Trisomy 21, 18, 13: Down, Edwards, Patau syndromes
• Other Syndromes: Turner, Triploidy, Meckel-Gruber, etc.

This guide encapsulates essential aspects of OB/GYN registry review, offering a consolidated overview of anatomy, pathologies, clinical indications, imaging techniques, and more, to aid in studying and revisiting key concepts.