Obstetrics Gynecology

A

• Abnormal Uterine Bleeding — Acute Hemodynamic Management

  Acute abnormal uterine bleeding in a nonpregnant reproductive-age patient ranges from heavy but stable bleeding to hemorrhagic shock. First exclude pregnancy-related bleeding, stabilize hemodynamics, assess anemia and coagulopathy, then use medical therapy such as combined hormonal therapy, high-dose progestin, or tranexamic acid when appropriate; uncontrolled bleeding requires tamponade, procedural, or surgical management.
• Adenomyosis — Diagnosis & Treatment

  Consider in heavy/painful menses and enlarged tender uterus. Diagnose with TVUS/MRI; treat with LNG‑IUD or other hormonal suppression; definitive therapy is hysterectomy when childbearing complete.
• Amenorrhea — Primary vs Secondary Workup

  Differentiate primary vs secondary amenorrhea; rule out pregnancy first; use targeted endocrine and anatomic evaluation to guide therapy.

C

• Cervical Insufficiency — Cerclage Indications

  Cerclage is indicated by a specific history, a high-risk history plus ultrasound shortening, or selected painless cervical dilation—not by every short cervix. In singleton pregnancies without prior spontaneous preterm birth, SMFM recommends vaginal progesterone for a cervix ≤20 mm before 24 weeks, consideration at 21–25 mm, and no cerclage for 10–25 mm without dilation.

E

• Eclampsia — Seizure Control and Blood Pressure

  Pregnancy related seizures require magnesium sulfate for seizure control, blood pressure management, and urgent obstetric delivery planning.
• Eclampsia — Seizure Control, BP Targets, and Delivery

  New-onset generalized seizures in pregnancy or postpartum related to preeclampsia; secure airway, give magnesium sulfate, control severe BP, and proceed to delivery after maternal stabilization.
• Eclampsia and Severe Preeclampsia — Magnesium, Blood Pressure Control, and Delivery

  New-onset seizures in pregnancy/postpartum (eclampsia) or preeclampsia with severe features. Stabilize airway/breathing, give magnesium sulfate for seizure control and prophylaxis, control blood pressure (labetalol, hydralazine, or nifedipine), and expedite delivery once maternal stabilized; manage HELLP and monitor fetus.
• Ectopic Pregnancy — Diagnosis & Management

  Ectopic pregnancy is implantation of a pregnancy outside the endometrial cavity, most often in the fallopian tube. Rupture can cause life-threatening intraperitoneal hemorrhage, so any reproductive-age patient with pregnancy, abdominal or pelvic pain, syncope, or vaginal bleeding requires assessment for hemodynamic instability. A positive pregnancy test without a definite intrauterine pregnancy is a pregnancy of unknown location, not automatically an ectopic pregnancy. Diagnosis often requires serial quanti
• Ectopic Pregnancy — hCG Algorithm, Methotrexate vs Surgery, and Rh Prophylaxis

  Suspect with abdominal pain, vaginal bleeding, and positive pregnancy test. Use transvaginal ultrasound and quantitative hCG trends; manage with single- or multi-dose methotrexate for stable, appropriate candidates or laparoscopic surgery for rupture/contraindications. Administer Rh immunoglobulin to Rh-negative patients.
• Ectopic Pregnancy — β‑hCG/Ultrasound Algorithm, Methotrexate Criteria, and Surgical Management

  Suspect ectopic with abdominal pain, vaginal bleeding, and positive pregnancy test. Use β‑hCG and transvaginal ultrasound to determine location; select methotrexate for stable, reliable patients meeting criteria; otherwise proceed to laparoscopic salpingostomy/salpingectomy. Rhogam for Rh‑negative patients.
• Endometriosis — Diagnosis & Medical/Surgical Management

  Endometriosis can often be diagnosed clinically from symptoms, examination, and targeted imaging without requiring diagnostic laparoscopy before treatment. Use ultrasound first when pelvic pathology is suspected, MRI selectively for deep disease or surgical mapping, offer empiric hormonal and analgesic therapy when appropriate, and reserve surgery for persistent symptoms, anatomic disease, infertility-related indications, or patient preference.

H

• Hyperemesis Gravidarum — ED Care

  Hyperemesis gravidarum is severe nausea and vomiting in pregnancy causing inability to maintain normal intake, dehydration, weight loss, electrolyte disturbance, and functional impairment. ED care focuses on excluding alternative diagnoses, restoring fluids and electrolytes, giving pregnancy-appropriate antiemetics and thiamine, and admitting patients who cannot maintain hydration or have significant metabolic or obstetric complications.

I

• Infertility — Initial Evaluation & When to Refer

  Time‑based definition by age; evaluate both partners; begin with ovulation, tubal patency, and semen analysis; refer early for complex factors or advanced reproductive techniques.
• IUD Complications — Malposition, Expulsion & Perforation

  Evaluate suspected IUD malposition, partial expulsion, missing strings, pain, bleeding, or pregnancy with history, pelvic examination, pregnancy testing when indicated, and ultrasound for localization. Management depends on device position, symptoms, pregnancy status, contraceptive goals, and whether perforation or partial expulsion is present; use person-centered counseling and avoid unnecessary removal of an asymptomatic normally functioning device.

O

• Ovarian Torsion — Clinical Suspicion, Ultrasound, and Laparoscopic Detorsion

  Sudden unilateral pelvic pain with nausea/vomiting in reproductive‑age or pregnant patients suggests torsion. Obtain transvaginal ultrasound with Doppler, but do not delay gynecologic consultation; prioritize ovary‑sparing laparoscopic detorsion when viable.
• Ovarian Torsion — Urgent Diagnosis and Detorsion

  Ovarian torsion is rotation of the adnexa around its vascular pedicle, producing venous obstruction followed by ischemia and potential ovarian necrosis. Sudden unilateral pelvic pain with nausea or vomiting should prompt urgent gynecologic evaluation; ultrasound supports the diagnosis, but preserved Doppler flow does not exclude torsion and surgery should not be delayed when clinical suspicion is high.

P

• Pelvic Inflammatory Disease — ED Treatment

  Pelvic inflammatory disease is an ascending infection of the upper genital tract that can cause endometritis, salpingitis, tubo-ovarian abscess, infertility, ectopic pregnancy, and chronic pelvic pain. Because diagnostic sensitivity is limited, treat empirically when a patient at STI risk has pelvic or lower abdominal pain with cervical motion, uterine, or adnexal tenderness and no better explanation.
• Placenta Accreta Spectrum — Antenatal Planning & Delivery

  Placenta accreta spectrum is safest when diagnosed before delivery and managed at a level III/IV center by a multidisciplinary team. Plan blood products and surgical resources, avoid placental disruption, and for most significant PAS perform cesarean hysterectomy with the placenta left in situ; stable planned delivery is commonly targeted for 34 0/7–35 6/7 weeks.
• Postpartum Hemorrhage — Acute Management

  Postpartum hemorrhage is an obstetric emergency in which visible blood loss can underestimate the degree of shock. Management requires immediate team activation, uterine assessment, quantitative blood-loss estimation, hemorrhage resuscitation, rapid treatment of uterine atony and other causes, tranexamic acid when appropriate, escalation to mechanical or procedural control, and early use of a massive transfusion pathway when bleeding is severe.
• Postpartum Hemorrhage — Initial Management

  Recognize early, activate massive hemorrhage protocol, perform uterine massage, give uterotonics, and escalate with tranexamic acid, balloon tamponade, and surgical control.
• Postpartum Hemorrhage — Uterotonics, Tranexamic Acid, and Balloon Tamponade

  PPH is blood loss ≥1000 mL or bleeding with signs of hypovolemia within 24 h of birth. Manage with uterine massage, first‑line uterotonics, early tranexamic acid, and stepwise escalation to balloon tamponade and surgical interventions with massive transfusion protocols.
• Postpartum Hemorrhage — Uterotonics, TXA, Balloon Tamponade, and Stepwise Escalation

  PPH is blood loss ≥1000 mL or bleeding with signs of hypovolemia within 24 h of birth. Activate PPH protocol: fundal massage and uterotonics (oxytocin first-line), add tranexamic acid within 3 hours, perform uterine balloon tamponade, and escalate to uterine artery embolization or surgical interventions (B-Lynch, hysterectomy) if refractory.
• Postpartum Hypertension — Recognition & Treatment

  Postpartum hypertension and preeclampsia may persist or first appear after delivery. Confirm repeated blood pressure elevation, evaluate headache, visual symptoms, dyspnea and end-organ injury, treat persistent severe-range blood pressure (at least 160 systolic or 110 diastolic) urgently, and use magnesium sulfate when eclampsia is present or seizure prophylaxis is indicated for severe disease.
• Preeclampsia and Eclampsia — ED Stabilization

  Preeclampsia with severe features and eclampsia are obstetric emergencies that can progress rapidly to stroke, pulmonary edema, hepatic injury, placental abruption, fetal compromise, and death. ED priorities are maternal stabilization, treatment of persistent severe hypertension, magnesium sulfate for seizure prevention or treatment when indicated, rapid laboratory assessment, and immediate obstetric involvement for delivery planning.
• Preterm Labor — Tocolytics, Steroids, and MgSO₄

  Preterm labor requires contractions plus cervical change or a sufficiently high-risk presentation. If preterm birth is likely, give antenatal corticosteroids in the appropriate gestational window, magnesium sulfate for fetal neuroprotection at very early gestations (commonly <32 weeks), and tocolysis only for a short steroid/transfer window when delaying delivery is safe.

S

• Septic Abortion — ED Resuscitation and Antibiotics

  Septic abortion is uterine and systemic infection associated with pregnancy loss or abortion and can progress rapidly to sepsis, hemorrhage, disseminated intravascular coagulation, and shock. Management requires immediate resuscitation, broad-spectrum IV antibiotics covering gram-positive, gram-negative, and anaerobic organisms, prompt uterine source control when retained infected tissue is present, and early obstetric consultation.

T

• TOLAC/VBAC — Counseling & Risk Assessment

  Most patients with one prior low-transverse cesarean and no contraindication to vaginal delivery can be offered TOLAC. Counsel on individualized VBAC likelihood and uterine-rupture risk, monitor continuously in labor where emergency cesarean is available, and do not use a prediction calculator as a cutoff for access.