Metropathia haemorrhagic

Also known as cystic glandular hyperplasia or Schroeder's disease.
It is specialised from of DUB.
In the condition the endometrium is thick and one or the other ovary contains cystic follicle.
It is most prevalent in women over 40yr and max between 40 to 45 yrs.
It may prevalent in over below 20 yrs.
Parity is not related to its incidence.
Symptoms
Most common complaint is amenorrhoea followed by continuous vaginal bleeding last for many weeks.
Bleeding is always painless since it is anovulatory.
Typical menstrual history
Type-1 in 50% cases continue vaginal bleeding is preceded by amenorrhoea of about 8 to 10 weeks
Types-2 In some patient bleeding follow normal pattern and occurs at the time of expected
Type-3  bleeding may be preceded by menorrhagia.
Differential diagnosis
Ectopic he station
Abortion
Gestational trophoblastic disease
Fibroid uterus
Endometrial cancer
Thyroid abnormalities
PID , Endometriosis
Emdometrial TB
PCOS
Treatment
 General
Anti-fibrinolytic agent-Tranexa 500 mg twice or TDS
NSAIDS
Ethamsylate 250 to 500 mg TDS oral/IV
GnRH agonists
Hormonal Method
1)Progestins 
   Tab.Nonethisterone (NE) 20-30mg/day 
2)Cyclical therapy  
    OCP is given from 5th to 25 th day for 3 consecutive cycles
     In ovular bleeding where patients wants pregnancy or in cases of irregular shedding or ripening dydrogesterone 10 mg per day from 16th to 25th day.
    MPA 10 mg 5th to 25 th day or NE 5mg 5th day to 25 th day for consecutive cycles.
DMPA 150 mg IM every 3 months
Surgical Management
Hysterectomy....

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Third Complications of labor

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Anatomy and physiology of Vagina to prevent infection

चित्र
In adult female ,vagina is lined by stratified squamous epithelium.In newborn female,it is lined by transitional epithelium.squamous epithelium is resistant to gonococcal infection.Thus , gonococal vaginitis cannot occur in adult female. Vagina has local inhabitant bacteria called Doderlein's bacillus Which breaks down the glycogen present in vaginal epithelium into lactic acid resulting in acidic pH(4-5.5, average 4.5) of vagina.The acidic pH of vagina acts as a barrier for external organism and protect from infection. Physiological vaginal discharge..... Clear, white and flocculent odourless discharge. Smear contains epithelial cells, lactobacillus pH ranges from 3.8 to 4.2 pH increase with increased oestrogen States:in pregnancy,OCP,mid-cycle,PCOS or premenarchal If pH increase in primenopausal woman, investigation for other effects of excess oestrogen. This area is subject to both primary and secondary infection.Ascending infection can occur from the vagina and c
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Antepartum Heamorrhage APH

चित्र
Antepartum haemorrhage APH APH is usually define as bleeding form the birth canal after the 24 to 28 weeks of  pregnancy.It can occur at any time until the second stage of lobour is complete; bleeding following the birth of the baby is postpartum haemorrhage=Miscarriage Or  Any ammount of bleeding from genital tract after 28 weeks to before of bleeding 28wk ..... Delivery time....6wk APH_________IPH_________PPH ETIOLOGY  --- Idiopathic/unknown 2types    1) Placenta previa (pp) 2) Abrupto previa (AP) Placenta previa=in lower uterin segement Implantation posterior wall of bady of uterus near the fundus Abrupto precisa=premature separation of placenta Most common risk of APH Dropping down theory= Drop down in lower uterine segments Implantation Due to less endometrial reactions Increase that cilliary active of fallopian tube A)Types of placenta previa 1)Types 1 (PP)  low lying place
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