Obstetrics and Maternal-Fetal Medicine
Astra Clinical Library
Obstetrics and gynecology
Practical obstetrics and gynecology guides for clinical decisions, with cited evidence, testing strategies, and actionable next steps.
23 guides
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Obstetrics and Gynecology
Ectopic Pregnancy
Ectopic pregnancy requires rapid exclusion of rupture, localization with transvaginal ultrasonography and serial quantitative hCG, and treatment matched to stability, pregnancy characteristics, follow-up reliability, and fertility priorities. Methotrexate is effective only in carefully selected, closely monitored patients; surgery is definitive for rupture or high-risk disease.Obstetrics and Gynecology
Postpartum Hemorrhage
Postpartum hemorrhage requires objective blood-loss measurement, immediate treatment linked to predefined triggers, rapid evaluation of tone, trauma, tissue, and thrombin, and early escalation when first-response measures fail. Current evidence supports a coordinated bundle rather than sequential, delayed intervention.Obstetrics and Gynecology
Placental Abruption
Placental abruption is a clinical diagnosis requiring immediate assessment of maternal hemodynamics, coagulation, and fetal status. Vaginal blood loss may substantially underestimate severity; management prioritizes resuscitation, early recognition of consumptive coagulopathy, and delivery based on maternal and fetal condition.Obstetrics and Gynecology
Preeclampsia
The supplied results do not contain preeclampsia-specific diagnostic criteria, prevention, treatment, delivery timing, medication dosing, or postpartum guidance. This topic requires consultation of current obstetric guidelines before point-of-care use.Gynecology and Gynecologic Oncology
Cervical Cancer
Cervical cancer care hinges on prevention through HPV-based screening, prompt risk-based evaluation of abnormal results, stage-appropriate local therapy, and biomarker-directed systemic treatment for persistent, recurrent, or metastatic disease.Obstetrics and Gynecology
Ovarian Torsion
Ovarian torsion is a time-sensitive surgical diagnosis. Neither normal Doppler flow nor nondiagnostic ultrasonography excludes torsion; when clinical concern persists, expedite gynecologic evaluation and diagnostic laparoscopy, with detorsion and ovarian preservation favored whenever technically feasible.Obstetrics and Gynecology
Pelvic Inflammatory Disease
Pelvic inflammatory disease is a clinical diagnosis requiring prompt empiric broad-spectrum treatment when pelvic organ tenderness accompanies lower genital tract inflammation in a patient at STI risk. Early management, reassessment, complication detection, and partner care are central to preventing reproductive sequelae.Obstetrics and Gynecology
Placenta Previa
Placenta previa requires transvaginal confirmation, assessment for vasa previa and placenta accreta spectrum, and individualized planning that balances recurrent hemorrhage against prematurity. Complete or partial os coverage precludes vaginal delivery; low-lying placentas require internal-os distance–based counseling and delivery planning.Obstetrics and Gynecology
Preterm Labor
Preterm labor requires separating contractions unlikely to lead to imminent birth from true cervical change, then using time-limited interventions to complete antenatal corticosteroids, provide neuroprotection, and arrange delivery at an appropriate neonatal center.Obstetrics and Gynecology
Gestational Diabetes
Gestational diabetes requires timely glucose-based diagnosis, nutrition and activity treatment, escalation to pharmacotherapy when glycemic targets are not met, and postpartum surveillance for type 2 diabetes risk. Treatment reduces important perinatal complications, while medication selection requires individualized maternal and fetal tradeoffs.Obstetrics and Gynecology
Abnormal Uterine Bleeding
Evaluate abnormal uterine bleeding by first excluding pregnancy and nonuterine bleeding, then stratifying endometrial cancer risk, identifying PALM-COEIN causes, and selecting imaging, sampling, medical therapy, or uterine intervention according to bleeding pattern and reproductive goals.Gynecologic Oncology
Endometrial Cancer
Endometrial cancer management hinges on diagnostic histology, extent of uterine and extrauterine disease, and molecular classification. Integrating MMR immunohistochemistry, POLE sequencing, and p53 testing refines hereditary-risk assessment, operative planning, prognosis, and systemic-treatment selection.Gynecologic Oncology
Vulvar Cancer
Manage vulvar cancer through biopsy-confirmed histology, clinically directed groin assessment, imaging for suspected nodal or advanced disease, and individualized primary excision with inguinofemoral staging. Sentinel-node techniques can reduce long-term morbidity in appropriately selected early-stage disease.Obstetrics and Gynecology
Genitourinary Syndrome of Menopause
A practical approach to confirming GSM, excluding competing vulvovaginal and urinary pathology, selecting local therapies, and individualizing treatment for patients with breast cancer or systemic hormone contraindications.Obstetrics and Maternal-Fetal Medicine
HELLP Syndrome
HELLP syndrome requires rapid confirmation of microangiopathic hemolysis, hepatic injury, and thrombocytopenia; stabilization of severe hypertension and seizure risk; exclusion of competing thrombotic microangiopathies and acute fatty liver; and delivery when maternal or fetal status warrants.Obstetrics and Gynecology
Premenstrual Syndrome
Diagnose clinically significant premenstrual syndrome by documenting luteal-phase symptoms, functional impact, and a symptom-free follicular interval. Prospective daily ratings distinguish PMS from premenstrual exacerbation of psychiatric or medical disease and direct treatment toward behavioral strategies, SSRIs, or ovulation suppression.Obstetrics and Gynecology
Premenstrual Dysphoric Disorder
Confirm PMDD with prospective daily ratings before attributing cyclic symptoms to a primary mood disorder. Distinguish PMDD from premenstrual exacerbation, assess suicidality urgently, and select SSRIs, ovulation suppression, or CBT according to symptom pattern, contraceptive needs, comorbidity, and treatment response.Obstetrics and Gynecology
Postpartum Hemorrhage Treatment Sequence
Treat postpartum hemorrhage as simultaneous resuscitation and source control: quantify loss, assess tone, trauma, tissue, and thrombin, give early tranexamic acid, escalate rapidly from uterotonics to tamponade or operative control, and replace fibrinogen before severe coagulopathy develops.Obstetrics and Gynecology
Ectopic Pregnancy Treatment Selection
Select expectant management, methotrexate, or surgery by first excluding instability and rupture, then integrating pain, ultrasound findings, hCG level, follow-up reliability, and fertility priorities. Serial hCG monitoring is mandatory after nonoperative treatment because clinical deterioration requires urgent reassessment.Obstetrics and Gynecology
Preterm Labor Antenatal Treatment
Select antenatal interventions by likelihood and timing of birth, gestational age, membrane status, infection or delivery indications, and neonatal-intent plan. Use a limited tocolytic bridge for steroids or transfer, magnesium sulfate for neuroprotection rather than tocolysis, and prompt delivery when maternal or fetal risks outweigh latency.Obstetrics and Gynecology
Preeclampsia Severe Features
Severe features shift preeclampsia management from outpatient surveillance to maternal stabilization, seizure prophylaxis, blood-pressure control, fetal assessment, and delivery planning. Delivery is indicated after stabilization at 34 weeks or sooner for uncontrolled maternal or fetal deterioration; selected patients before 34 weeks may undergo inpatient expectant management.Obstetrics and Gynecology