Obstetrics & Gynecology (OBG) –

 ### **Obstetrics & Gynecology (OBG) – Pregnancy, Childbirth & Female Reproductive Health** **OBG** is a core subject in **final-year MBBS** but its basics start in **second-year MBBS** through **anatomy (female reproductive system), physiology (menstrual cycle, pregnancy changes), and pathology (gynecological disorders)**. It covers **pregnancy, childbirth, postpartum care, contraception, infertility, and female reproductive diseases**. --- ## **Main Topics in Obstetrics & Gynecology** ### **1. Obstetrics (Pregnancy & Childbirth)** - **Physiological Changes in Pregnancy** - Increased cardiac output, respiratory rate, and blood volume - Hormonal changes: **hCG, Progesterone, Estrogen** - **Signs of Pregnancy** - **Presumptive Signs**: Amenorrhea, Breast tenderness, Morning sickness - **Probable Signs**: Hegar’s sign (Soft uterus), Chadwick’s sign (Blue cervix) - **Definitive Signs**: Fetal heartbeat (Doppler at 10-12 weeks), USG fetal movement --- ### **2. Antenatal Care (ANC)** ✅ **1st Visit (Before 12 weeks)** – Blood tests (Hb, Blood group, VDRL, HIV, HBsAg), USG ✅ **4 ANC Visits** – Every **4 weeks till 28 weeks**, **2 weeks till 36 weeks**, **weekly till delivery** ✅ **Folic Acid (400 mcg/day) in 1st Trimester** to prevent **Neural Tube Defects** ✅ **Iron & Calcium Supplementation from 14 weeks** - **Routine Investigations in Pregnancy** - **USG**: First-trimester viability scan, NT scan (11-13 weeks for Down syndrome), Anomaly scan (18-22 weeks) - **Gestational Diabetes Screening (24-28 weeks)**: OGTT (75g glucose) - **Rh Incompatibility Screening** (Indirect Coombs Test at 28 weeks) --- ### **3. Common Pregnancy Complications** - **Preeclampsia & Eclampsia** - BP >140/90 + Proteinuria after 20 weeks - **Treatment**: Labetalol, Magnesium sulfate for seizures - **Gestational Diabetes Mellitus (GDM)** - Diagnosed with OGTT (75g Glucose, >140 mg/dL at 2 hours) - **Treatment**: Diet control, Insulin if needed - **Placenta Previa** (Low-lying placenta) vs. **Abruptio Placentae** (Premature placental separation) - **Placenta Previa** → **Painless bleeding** in 3rd trimester - **Abruptio Placentae** → **Painful bleeding** with fetal distress - **Management**: Hospitalization, C-section if severe --- ### **4. Labor & Delivery** - **Stages of Labor** 1️⃣ **First Stage**: Latent (0-4 cm), Active (4-10 cm) – **Cervical dilation** 2️⃣ **Second Stage**: **Delivery of baby** 3️⃣ **Third Stage**: **Delivery of placenta** (Watch for PPH) - **Mechanism of Normal Labor** (Engagement, Descent, Flexion, Internal rotation, Extension, External rotation) - **Instrumental Delivery** – Forceps, Vacuum extraction - **C-section Indications** – Fetal distress, Placenta previa, CPD --- ### **5. Postpartum Care** - **Puerperium (6 weeks after delivery)** – Uterus involution, Lochia - **Postpartum Hemorrhage (PPH)** - Blood loss >500 ml (Vaginal) or >1000 ml (C-section) - Causes: **Tone (Uterine atony), Trauma, Tissue (Retained placenta), Thrombin (Clotting disorder)** - **Treatment**: **Uterotonics (Oxytocin, Misoprostol), Bimanual compression** --- ## **Gynecology (Female Reproductive Health & Disorders)** ### **6. Menstrual Disorders** - **Menstrual Cycle Phases**: Follicular (Estrogen), Ovulatory (LH Surge), Luteal (Progesterone) - **Common Disorders**: - **Amenorrhea (No periods)** – Primary (Turner’s Syndrome), Secondary (PCOS, Pregnancy) - **Dysmenorrhea (Painful periods)** – Primary (Normal), Secondary (Endometriosis) - **Menorrhagia (Heavy bleeding)** – Fibroids, Endometrial Hyperplasia --- ### **7. Polycystic Ovarian Syndrome (PCOS)** - **Symptoms**: Irregular periods, Hirsutism, Acne, Obesity - **Diagnosis**: Rotterdam criteria (Oligomenorrhea + Hyperandrogenism + Polycystic ovaries on USG) - **Treatment**: - Weight loss, **OCPs (Oral Contraceptive Pills)** for cycle regulation - **Metformin for insulin resistance** --- ### **8. Infertility & Contraception** - **Infertility**: - Male causes (Low sperm count, Varicocele), Female causes (PCOS, Tubal blockage) - **Treatment**: Ovulation induction (Clomiphene), IVF if needed - **Contraception Methods**: - **Barrier**: Condoms (Prevent STDs) - **Hormonal**: OCPs, Injectables (Depo-Provera), Implants - **IUDs**: Copper-T (10 years), Mirena (5 years, Hormonal) - **Permanent**: Tubal ligation, Vasectomy --- ### **9. Gynecological Cancers** - **Cervical Cancer (Most common in India)** - Caused by **HPV 16, 18** - **Screening**: Pap Smear (From 21 years, Every 3 years) - **Prevention**: **HPV Vaccine (9-26 years)** - **Ovarian Cancer** - Symptoms: **Bloating, Pelvic mass, Weight loss** - Diagnosis: CA-125 marker, USG - **Endometrial Cancer** - Symptoms: **Postmenopausal bleeding** - Risk Factors: **Obesity, PCOS, Estrogen therapy** --- ### **10. Gynecological Surgeries** - **D&C (Dilation & Curettage)** – Miscarriage, Heavy bleeding - **Hysterectomy (Uterus removal)** – Fibroids, Endometriosis, Cancer - **Oophorectomy (Ovary removal)** – Ovarian cysts, Cancer --- ## **Study Tips for OBG** ✅ **Use mnemonics** (e.g., **"FOLLICLE" for PCOS features - FSH imbalance, Oligomenorrhea, LH high, Insulin resistance, Cysts, Lack of ovulation, Estrogen excess**) ✅ **Understand Antenatal Care & Contraception well** (Common exam topics) ✅ **Watch videos on labor mechanisms & surgical procedures** ✅ **Refer to DC Dutta’s Obstetrics & Shaw’s Gynecology** ---

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