Reproductive
What you must know
Obstetrics: establish dating (crown-rump length in the first trimester), offer aneuploidy screening, and screen for gestational diabetes at 24-28 weeks. Hypertensive disorders of pregnancy begin after 20 weeks; preeclampsia is new hypertension with proteinuria or end-organ dysfunction, and severe features (blood pressure 160/110 or higher, platelets under 100, elevated transaminases, renal insufficiency, pulmonary edema, visual or cerebral symptoms) mandate magnesium for seizure prophylaxis and delivery. Eclampsia is a seizure in that setting. Ectopic pregnancy is the classic emergency: risk factors, positive hCG, and no intrauterine pregnancy; methotrexate only for a hemodynamically stable patient without rupture who meets criteria. Rh-negative patients with bleeding or after delivery need immune globulin.
Gynecology: contraception counseling should include long-acting reversible methods as the most effective. Abnormal uterine bleeding is organized by PALM-COEIN (structural versus nonstructural causes). Polycystic ovary syndrome uses Rotterdam criteria (two of three: oligo-ovulation, hyperandrogenism, polycystic ovaries). Screen for chlamydia and gonorrhea in at-risk patients and treat partners. Menopause is clinical; hormone therapy is for vasomotor symptoms in appropriate candidates.
Other: testicular torsion is a surgical emergency regardless of Doppler result. Prostate cancer screening is a shared decision using PSA. Infertility workup begins after 12 months of trying (6 months if age 35 or older).
Traps
- Attributing abdominal pain in a reproductive-age woman to gastroenteritis without a pregnancy test.
- Giving methotrexate to a patient with a ruptured or large ectopic pregnancy.
- Forgetting Rh immune globulin after bleeding or delivery.
- Treating bacterial vaginosis with fluconazole.
Rule of thumb
Pregnancy test first in any reproductive-age woman with abdominal pain, syncope, or vaginal bleeding.