Devine Intervention: High-Yield OB-GYN for Third Year Shelf Exam

Jul 24, 2024

Devine Intervention: High-Yield OB-GYN for Third Year Shelf Exam

General Information

  • Presenter: Devine, 4th-year medical student
  • Objective: Review high-yield OB-GYN material for third-year shelf exam
  • Disclaimers: No financial disclosures; emphasis on independent reading and advice

Clinical Scenarios and Key Concepts

Postpartum Management

  • Case: 22-year-old G1P1 female, 1 week postpartum, wants next baby in 2 years.
    • Delivered 6-pound, 4-ounce boy with Apgar scores of 8 and 9.
    • Focus on contraception suitable for breastfeeding: avoid estrogen-containing OCPs.
    • Diagnosis and Management: Progestin-only contraceptive (e.g., DMPA injection).

Breastfeeding and Conditions

  • Breastfeeding Benefits:
    • Prolactin-induced suppression of HPG axis decreases ovarian cancer risk.
    • Weight loss post-pregnancy.
  • Conditions and Contraindications:
    • Avoid breastfeeding if mother has HIV, TB, active herpes, or infant has galactosemia.
    • Reassure for postpartum blues; treat postpartum depression with SSRIs.

Postpartum Infections

  • Endometritis: Common after cesarean delivery.
    • Lab Signs: Fever, tender uterus, foul-smelling lochia.
    • Treatment: Clindamycin and Gentamicin (ECG mnemonic).
  • Chorioamnionitis: Infection of amniotic fluid, usually after prolonged rupture of membranes.
    • Signs: Maternal fever, fetal tachycardia, smelly amniotic fluid.
    • Treatment: Ampicillin and Gentamicin (CAG mnemonic).

Gestation and Pregnancy Calculations

  • Diagnosing Pregnancy:
    • Check Beta HCG (both urine and serum); serum appears earlier.
  • Nagel's Rule: LMP + 7 days - 3 months + 1 year.
  • TPAL System: Term, Preterm, Abortion, Living children.

Hormonal Changes in Pregnancy

  • Changes include increased plasma volume, decreased SVR, increased cardiac output, and more.
  • Key Changes: Increased CO, dilation of ureters, reduced albumin.

Gestational Complications

  • Gestational Diabetes:
    • Screen between 24-28 weeks; 1-hour glucose test followed by 3-hour confirmatory test.
    • Complications: Macrosomia, Neonatal hypoglycemia, Polyhydramnios.
  • Ruptured Membranes: Types of PROM and associated risks.
  • Fetal Heart Rate: RECO Tactic for accelerations/decelerations and patterns.

Hypertensive Disorders

  • Categories: Chronic hypertension, Gestational hypertension, Preeclampsia (with severe features if end organ damage), and Eclampsia.
  • Treatment: Magnesium for seizure prophylaxis and IV antihypertensives (e.g., Labetalol).

Examination Techniques and Disease Identification

  • Fetal Heart Rate Interpretation: Gradual or abrupt changes and their implications.
  • Postpartum Hemorrhage: Causes (Tone, Tear, Tissue, Thrombin, Topsy-turvy), treatments.
  • Male and Female Sexual Development: Impact of hormones and developmental stages.
  • Molar Pregnancy and Choriocarcinoma: Diagnosis by high HCG and snowstorm appearance; treat with methotrexate.

Examinations and Diagnostics

  • Amniotic Fluid Index (AFI): Diagnosing oligohydramnios vs. polyhydramnios.
  • Placental Complications: Placenta Previa and Accreta diagnosis.
  • Cancer Detection: Importance of history and biopsy in diagnosing vulvar and cervical cancers.

Summary and Quick Tips

  • Mnemonic Techniques:
    • VLCHOP for interpreting fetal heart rate patterns (Variable, Late, Early decels).
    • CAG for chorio (Ampicillin and Gentamicin) and ECG for endometritis.
  • Guidelines: Regular screening for asymptomatic bacteriuria in pregnancy, correct vitamins and necessary vaccinations.

Pitfalls to Avoid:

  • Never perform digital cervical examinations in cases of suspected previa before ultrasound confirmation.
  • Carefully manage medications in specific conditions (e.g., avoid ACE inhibitors in pregnancy).

References

  • Preparation for OB-GYN exams, relevant textbooks, and study guides.

Best of luck on your exams!