In this video, the presenter provides an overview of key points in obstetrics and gynecology (OB/GYN). They cover topics such as postpartum hemorrhage, active phase of delivery, fetal tachycardia, placental abruption, preeclampsia, neonatal infections, and more. They discuss common causes, diagnosis, and treatment options for these conditions. The presenter also touches on other aspects of OB/GYN, including breast abscesses, breastfeeding, and gestational diabetes. Overall, the video provides a comprehensive review of important concepts in OB/GYN for medical professionals preparing for exams or seeking a general overview.
Key Insights:
- Postpartum hemorrhage: Main cause is uterine atony. Diagnose based on uterus above umbilicus. Treat with uterine massage and oxytocin if needed.
- Retained placenta: Common cause of postpartum hemorrhage. Diagnose with incomplete placenta on ultrasound. Treat with D&C.
- Lacerations: Another cause of postpartum hemorrhage, associated with forceps delivery. Diagnose with below umbilicus uterus on ultrasound. Treat with pelvic examination and suturing.
- Active phase of delivery: Defined as 6 cm to 10 cm cervical dilation. Arrest of active phase defined as 4 hours of adequate contractions or 6 hours of inadequate contractions.
- Uterus rupture: Associated with intense pain and change in baby’s station. Requires c-section.
- Elapsed cord: Umbilical cord prolapse through cervix. Requires c-section.
- Fetal tachycardia: Normal heart rate for fetus is 110-160 bpm. Fetal tachycardia can be caused by maternal fever.
- Tocolytics: Terbutaline is the first-line tocolytic for premature labor. Adverse effect is pulmonary edema.
- Thalassemia: Beta thalassemia can be distinguished by elevated hemoglobin A2.
- Preeclampsia and eclampsia: Preeclampsia is hypertension with proteinuria. Eclampsia is preeclampsia with seizures. Treat with magnesium and deliver the baby.
- Placental abruption: Associated with trauma, hypertension, cocaine use, and smoking. Presents with painful vaginal bleeding. Diagnosis confirmed with ultrasound.
- Placenta previa: Abnormal placental position, painless bleeding. Increased risk in c-section scar and prior placenta previa cases.
- Cholangitis of pregnancy: Severe itching, elevated liver enzymes, and elevated systemic bile acid levels. Treat with ursodeoxycholic acid.
- Postpartum thyroiditis: Presents as transient hyperthyroidism followed by hypothyroidism after childbirth. Iodine uptake is low.
- Neonatal infections: Group B Strep, E. coli, and Listeria are common causes in babies less than three months old.
- Pyloric stenosis: Projectile nonbilious vomiting in a 3-week-old baby. Treat with surgery.
- Treatment for maternal infections: Herpes simplex virus, chancroid, gonorrhea, and chlamydia require specific management.
- Amniotic fluid embolism: Presents like a PE, associated with c-section and abruption. Supportive treatment.
- Diabetes in pregnancy: Gestational diabetes diagnosed at week 28 by glucose tolerance test. First-line treatment is diet, followed by insulin if needed.
- Breastfeeding: Breast milk has more antibodies and protective factors than formula milk. Exclusive breastfeeding for the first 6 months is recommended.
- Complications after delivery: Endometritis, breast abscess, and postpartum thyroiditis are common postpartum issues that require treatment.
Transcript
What’s up guys, welcome to another video. Today we’re gonna cover OB/GYN. We’re gonna do a super cram session to try and cover as much as we can in the time we have here. This is intended to be basically a last-minute overview to go over all the must-know points for your OB going for either Step 2 CK or for your shelf. Hopefully, this is helpful. Let’s start first, we’re gonna cover obstetrics.
So, postpartum hemorrhage is defined as over 500 milliliters of vaginal bleeding or over 1 liter from a c-section, and the most common cause is due to uterine atony. That’s when the uterus is weak after delivery and can’t contract properly, leading to bleeding. Look for the uterus being above the umbilicus in the vignette. The first-line treatment is uterine massage and giving oxytocin if needed. Retained placenta and lacerations are other common causes of postpartum hemorrhage. Treat retained placenta with a D&C, and suture lacerations if needed.
Next, we move on to the active phase of delivery. The active phase begins at 6 centimeters cervical dilation and ends at 10 centimeters. If there is no progress after four hours of adequate contractions or six hours of inadequate contractions, it’s called arrest of active phase, and a c-section is needed. Adequate contractions are loosely defined as contractions every two to three minutes or greater than 200 Montevideo units in ten minutes. Arrest of descent occurs when there is no progress after three hours of maximum dilation of the cervix and is usually caused by cephalopelvic disproportion. This is also treated with a c-section.
Other obstetric complications include uterine rupture and umbilical cord prolapse. Uterine rupture is characterized by sudden intense pain and the baby’s head moving up in the vagina. It requires immediate c-section. Umbilical cord prolapse occurs when the umbilical cord slips through the cervix and obstructs the path of vaginal delivery. This also requires a c-section.
Moving on to fetal conditions, fetal tachycardia is when the heart rate is higher than 160. This is usually caused by maternal fever. To monitor fetal well-being, we look for fetal heart rate accelerations during non-stress tests. The rule of 15 is commonly used, where if there are two accelerations in a 20-minute period, it indicates good oxygenation. If the non-stress test is inconclusive, a biophysical profile can be done to assess fetal movement, tone, breathing, and amniotic fluid measurements. A score of less than four indicates the need for immediate delivery.
Next, we discuss maternal infections. Endometritis is inflammation of the endometrium and is commonly associated with c-sections or ascending infections. It presents with a tender uterus, fever, and foul-smelling lochia. Treat with clindamycin and gentamicin. Chorioamnionitis, also caused by ascending infection, is associated with prolonged rupture of membranes. Treat with ampicillin and gentamicin.
Common infections in neonates include Group B Streptococcus, E. coli, and Listeria. They present with respiratory distress and sepsis. Treat with ampicillin and gentamicin until culture results are available.
Other topics covered include complications of delivery, such as shoulder dystocia, neonatal infections, breast abscesses, and postpartum thyroiditis. Gestational diabetes is also discussed, along with other prenatal visits and screenings. The video provides a comprehensive overview of important concepts in obstetrics and gynecology.
