Devine Intervention Podcast - Obstetrics and Gynecology High-Yield Material

Presented by: Devine, Fourth-Year Medical Student

Overview

• Review of high-yield material for the third-year Obstetrics and Gynecology shelf exam.

Test-Taking Strategies

• Advice for third-year students.
• Importance of reviewing concepts thoroughly.

Clinical Scenario Discussions

Postpartum Contraceptive Management

• Case: 22-year-old G1P1 female, postpartum, plans next pregnancy in two years.
• Key Point: Avoid estrogen-containing contraceptives for breastfeeding women.
• Solution: Administer progestin-only contraceptives (e.g., DMPA injection).
• Mechanism: Thickening of cervical mucus, protection against endometrial cancer.

Breastfeeding Considerations

• High prolactin state suppresses HPG axis, reduces risk of breast cancer and ovarian cancer.
• Contraindications to breastfeeding: HIV, active TB, galactosemia.
• Mastitis: continue breastfeeding, treat with dicloxacillin.

Postpartum Psychological Disorders

• Postpartum Blues: Reassure and provide support.
• Postpartum Psychosis: Involuntary hospitalization, antipsychotics.
• Postpartum Depression: Start with SSRIs.

Endometritis Post-Cesarean

• Case: 33-year-old G2P2002, fever, foul-smelling lochia post-Cesarean.
• Risk Factor: Cesarean delivery.
• Treatment: Clindamycin and gentamicin.

Pregnancy Basics

• GTPAL System: Understanding gravity and parity.
• Physiological Changes: Blood volume up, systemic vascular resistance down, cardiac output up, etc.

Diagnostic Timelines for Pregnancy

• Beta HCG: Key for confirming pregnancy.
• Nagel's Rule: Calculating due date.

Important Conditions and Management

Intrauterine Fetal Demise

• Action: Induce labor with oxytocin, vaginal delivery preferred.

Prenatal Testing

• Routine Tests: Urinalysis for asymptomatic bacteriuria.
• Key Timing: RHD immune globulin, GBS swab, gestational diabetes screening, etc.

Gestational Diabetes

• Screening: 24-28 weeks.
• Management: Diet, exercise, insulin preferred; metformin and glyburide gaining acceptance.

Hypertension in Pregnancy

• Types: Chronic, gestational, preeclampsia, eclampsia.
• Treatment: Labetalol, nifedipine; delivery for eclampsia.

Teratogens

• Key Agents: Lithium (Ebstein anomaly), ACE inhibitors (renal problems), Warfarin (bleeding).

Breast Cancer

• Screening Guidelines: USPSTF vs American Cancer Society.
• Common Diagnoses: Invasive ductal carcinoma, LCIS receptor positivity.

Fetal Heart Rate Tracings

• Normal Range: 110-160 bpm.
• Decelerations: Early (head compression), late (uteroplacental insufficiency), variable (cord compression).

Pregnancy Complications

Molar Pregnancy

• Diagnosis: Suction curettage for complete moles.
• Follow-up: Monitor beta HCG, prevent pregnancy during follow-up.

Ectopic Pregnancy

• Risk Factors: PID, smoking.
• Management: Methotrexate or surgical intervention.

Spontaneous Abortion

• Classifications: Threatened, inevitable, incomplete, complete, missed.

Infectious Diseases in Pregnancy

• ToRCH Infections: Toxoplasmosis, rubella, CMV, HSV, syphilis.

Contraception and Menstrual Disorders

• PCOS: Key clinical features and management strategies.
• Abnormal Uterine Bleeding: Causes and diagnostic approaches.

Postpartum Hemorrhage

• Causes: Uterine atony, lacerations, retained tissue.
• Management: Uterine massage, oxytocin, surgical intervention if necessary.

Summary

• Comprehensive review of OB-GYN shelf exam topics.
• Emphasis on understanding key clinical scenarios and management strategies.

Note: For detailed explanations and additional questions, refer to the extended slides and materials provided during the podcast.