How should I organize a 2-hour lecture on OBGYN topics, prioritizing emergencies like abruptio placentae and postpartum hemorrhage, and covering non-emergent topics such as breast disorders and infertility?

2-Hour OBGYN Lecture Outline: Emergency-First Approach

PART 1: OBSTETRIC EMERGENCIES (60 minutes)

A. Hemorrhagic Emergencies (20 minutes)

Postpartum Hemorrhage

• Administer oxytocin 5-10 IU via slow IV or IM injection immediately at shoulder release or postpartum as first-line prophylaxis 1, 2
• If bleeding occurs despite oxytocin, give tranexamic acid 1 gram IV within 1-3 hours of bleeding onset (NNT: 276 to prevent one maternal death) 1, 2, 3
• Critical pitfall: Delaying tranexamic acid beyond 3 hours significantly reduces effectiveness 1, 3
• Ensure immediate availability of large-bore IV catheters, fluid warmers, forced-air body warmers, and rapid infusion devices 1, 3
• Establish massive transfusion protocol with blood bank resources 1

Abruptio Placentae

• Presents with vaginal bleeding (usually dark blood), abdominal pain, and uterine contractions 4, 5
• Occurs in 0.6-1.2% of all pregnancies, with nearly half occurring at term 4
• Grade III abruption (fetal death) indicates severe form with real risk of overt coagulopathy developing 6
• Risk factors include previous abruption, hypertensive diseases, abdominal trauma, growth restriction, and smoking 5
• Management: Aggressive volume resuscitation followed by expeditious delivery—cesarean section when fetus is alive and viable, vaginal delivery when fetus is dead 5, 6
• Prolongation of abruption-delivery interval worsens maternal prognosis 6

Placenta Previa

• Included in common hemorrhagic complications requiring specific management protocols 7

B. Hypertensive Emergencies (15 minutes)

Severe Pre-eclampsia/Eclampsia

• Represents acute neurological and cardiovascular emergency requiring immediate blood pressure control and seizure prophylaxis 3
• Administer magnesium sulfate as first-line therapy for eclamptic seizures 1, 2, 3
• Initiate antihypertensive treatment immediately to prevent intracranial hemorrhage 1
• Coordinate immediately with emergency services 1, 2, 3
• Maintain strict fluid balance and clear documentation 2

C. Delivery-Related Emergencies (15 minutes)

Imminent Delivery Assessment

• Systematically assess: multiparity, history of previous rapid or non-hospital delivery, regular painful uterine contractions, and urge to push 2, 3
• Perform cervical examination before contacting receiving obstetric team to optimize triage 2, 3
• Critical pitfall: Risk of delivery during transport constitutes contraindication to in utero transfer 8

Shoulder Dystocia

• Position patient for McRoberts maneuver if anticipated 2, 3
• Requires rapid recognition and systematic approach 8

Obstructed Labor

• Assess for cephalopelvic disproportion before proceeding with augmentation (occurs in 25-30% of active phase arrest cases) 2, 3
• Oxytocin augmentation is first-line treatment with 92% success rate for vaginal delivery when cephalopelvic disproportion is absent 2, 3
• For impacted fetal head at cesarean: use manual vaginal disimpaction, fetal pillow, assistant pushing head up from vagina, reverse breech extraction, and tocolysis 1, 2

Umbilical Cord Prolapse

• Requires immediate recognition and intervention 8

Breech Presentation

• May require reverse breech extraction technique during cesarean delivery 2

D. Cardiopulmonary Emergencies (10 minutes)

Maternal Cardiac Arrest

• Initiate standard ACLS protocols immediately with continuous left uterine displacement to relieve aortocaval compression 2
• Critical 4-minute rule: Prepare for emergency cesarean delivery at 4 minutes regardless of gestational age if uterus is at or above umbilicus 1, 2, 3
• Critical pitfall: Failure to recognize the 4-minute window leads to poor maternal and fetal outcomes 3
• Designate timekeeper to call out times at 1-minute intervals 1
• Circulation must be restored within 4 minutes before proceeding to perimortem cesarean 2

Amniotic Fluid Embolism

• Use cognitive aid checklist focusing on ABC principle: Airway, Breathing, Circulation 1, 2, 3
• Secure airway immediately if respiratory distress and seizure activity occur to prevent aspiration 1, 3
• Transfer to ICU immediately given multi-system involvement with respiratory failure, neurological compromise, and coagulopathy 3
• Avoid prostaglandin F2α and ergometrine in patients with respiratory distress 3

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PART 2: NON-EMERGENT PREGNANCY TOPICS (30 minutes)

A. Pregnancy Complications (15 minutes)

Gestational Diabetes

• Glycemic targets in pregnancy are stricter than in nonpregnant individuals 8
• Management achieved through combination of insulin administration and medical nutrition therapy 8
• Women with diabetes should eat consistent amounts of carbohydrates to match insulin dosage and avoid hyperglycemia or hypoglycemia 8

Hypertensive Disorders of Pregnancy

• Women of reproductive age should have blood pressure checks during routine care 8
• If diagnosed with hypertension, counsel on lifestyle changes and medications safe in pregnancy 8

Multiple Gestation

• Requires specific management protocols 8

Gestational Trophoblastic Disease

• Requires early recognition and appropriate referral 8

Rh Incompatibility

• Screen and manage according to established protocols 8

B. Prenatal and Postpartum Care (15 minutes)

Preconception/Prenatal Care

• All women of reproductive age should take folic acid and consume balanced, healthy diet including folate-rich foods 8
• Women at high risk of neural tube defects should take higher levels of folic acid 8
• Discuss reproductive goals and issues at each visit 8
• Assess social history, lifestyle, and behavioral issues that may affect pregnancy 8
• Screen for alcohol consumption, tobacco use, and drug use 8

Postpartum Care

• ACOG recommends shifting from single visit to comprehensive set of visits customized to woman's needs during "fourth trimester" 8
• Monitor for postpartum hemorrhage, which may necessitate immediate transfusion, administration of oxytocics, and/or uterine manipulation 6
• Screen for postpartum psychiatric disorders 8
• Address postpartum pituitary disorders 8

Labor/Delivery Management

• Establish standardized approaches to emergency obstetric care 8
• Develop safety bundles addressing obstetric emergencies such as hemorrhage, severe hypertension, and venous thromboembolism 8

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PART 3: NON-EMERGENT GYNECOLOGIC CONDITIONS (30 minutes)

A. Breast Disorders (8 minutes)

Mastitis and Abscess

• Differentiate between inflammatory mastitis and abscess requiring drainage 8

Fibroadenoma

• Benign solid breast mass requiring clinical assessment 8

Fibrocystic Changes

• Common benign condition requiring reassurance and symptom management 8

Galactorrhea

• Evaluate for hyperprolactinemia and other endocrine causes 8

Gynecomastia

• Assess for physiologic versus pathologic causes 8

B. Cervical and Uterine Disorders (8 minutes)

Cervicitis

• Screen for sexually transmitted infections 8
• Provide appropriate antimicrobial therapy 8

Cervical Dysplasia

• Follow established screening and management guidelines 8

Cervical Insufficiency

• Consider cerclage placement in appropriate candidates 8

Endometriosis

• Diagnose based on clinical presentation and imaging 8
• Manage with medical and/or surgical approaches 8

Leiomyoma (Fibroids)

• Assess size, location, and symptoms 8
• Offer medical management or surgical options based on patient goals 8

Uterine Prolapse

• Evaluate degree of prolapse and impact on quality of life 8

C. Ovarian Disorders (6 minutes)

Ovarian Cysts

• Differentiate functional versus pathologic cysts 8

Polycystic Ovary Syndrome

• Diagnose using Rotterdam criteria 8
• Address metabolic, reproductive, and cosmetic concerns 8

Ovarian Torsion

• Recognize as surgical emergency requiring immediate intervention 8

D. Vaginal/Vulvar Disorders (4 minutes)

Vaginitis

• Differentiate bacterial vaginosis, candidiasis, and trichomoniasis 8

Bartholin Gland Cysts

• Manage with observation, drainage, or marsupialization 8

Pelvic Organ Prolapse (Cystocele, Rectocele)

• Assess degree and offer conservative versus surgical management 8

E. Infections and Contraception (4 minutes)

Pelvic Inflammatory Disease

• Provide prompt antimicrobial therapy to prevent sequelae 8

Contraceptive Methods

• When pregnancy is not desired, discuss safe sex and effective contraceptive methods 8
• Offer full range of contraceptive methods with appropriate counseling tailored to each patient's preference 8
• Counsel women on importance of birth spacing 8

Human Sexuality and Gender Identity

• Provide inclusive, non-judgmental care 8

Infertility

• Evaluate both partners systematically 8
• Women with BMI ≥30 or <18.5 kg/m² should be counseled about possible infertility issues 8

Menopause

• Address vasomotor symptoms, genitourinary syndrome, and long-term health 8

Menstrual Disorders

• Evaluate abnormal uterine bleeding systematically 8

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CRITICAL SYSTEM-LEVEL PREPAREDNESS POINTS

Essential Resources

• Establish direct contact between on-call obstetrician and emergency medical services 1, 2, 3
• Ensure immediate availability of basic and advanced life-support equipment in labor and delivery units 3
• Stock drugs commonly available in obstetric units 1
• Have rigid laryngoscope blades, videolaryngoscopic devices, and endotracheal tubes of assorted sizes immediately available 1

Staff Education

• Educate all staff about pregnancy-specific resuscitation modifications 1
• Provide emergency obstetric training for all personnel managing deliveries 3
• Lack of standardized approaches to emergency obstetric care contributes to poor maternal outcomes 3

Critical Pitfalls Summary

• Not having hemorrhage management resources immediately available delays critical interventions 3
• Underestimating physiological changes of pregnancy complicates airway management 3
• Failing to maintain left uterine displacement during resuscitation perpetuates aortocaval compression 3