Emergency medicine references.
#Emergency

**"قد عاد عيدُ المسلمينَ فكبِّروا
فالله من كلِ الوجود الأكبرُ!"

عيد أضحى مُبارك وكل عام وأنتم بخير✨ ??**
..

*⭕️Uretovaginal fistula :*
-continuous incontinence with normal desire to voiding (as the other ureter is connected to the bladder normally)
-usually occur after hysterectomy
-Ix : retrograde cysto-uretrogram
-Rx : re-implantation of ureter (but if the fistula is small, you can use stent for 3 months and see the result)

*⭕️Vesicovaginal fistula :*
-continuous incontinence without normal desire to voiding
-usually after C-section
-Ix : retrograde cysto-uretrogram
-Rx : obliterate the fistula from the bladder after 6 w

#Gynecology

A 20-year-old G1 at 38 weeks gestation presents with regular painful contractions every 3 to 4 minutes lasting 60 seconds. On pelvic examination, she is 3 cm dilated and 90% effaced; an amniotomy is performed and clear fluid is noted. The patient receives…

A 20-year-old G1 at 38 weeks gestation presents with regular painful contractions every 3 to 4 minutes lasting 60 seconds. On pelvic examination, she is 3 cm dilated and 90% effaced; an amniotomy is performed and clear fluid is noted. The patient receives epidural analgesia for pain management. The fetal heart rate tracing is reactive. One hour later on repeat examination, her cervix is 5 cm dilated and 100% effaced. Which of the following is the best next step in her management?

a. Begin pushing
b. Initiate Pitocin augmentation for protracted labor
c. No intervention; labor is progressing normally
d. Perform cesarean delivery for inadequate cervical effacement
e. Stop epidural infusion to enhance contractions and cervical change

#Obstetric