OB/GYN

  • Bartholin Gland Abscess I&D
  • Normal Spontaneous Vaginal Delivery
  • Resuscitative Hysterotomy
  • Shoulder Dystocia Management

Bartholin Gland Abscess I&D

  • Background
    • Common techniques for incision and drainage of bartholin gland abscesses include marsupialization and fistulization with word catheter
  • Indications
    • Symptomatic abscesses that are at least 1 cm in diameter
  • Contraindications
    • No absolute contraindications. Relative contraindications include complex abscesses requiring general anesthesia.
  • Complications
    • Recurrence (30%), bleeding, infection.
Video Credit: Medmastery

*Deep Dive: What’s the Word on Word Catheters? (First 10 EM)

Normal Spontaneous Vaginal Delivery

  • Background
    • Uncomplicated, vaginal delivery of full-term (37-42 week) newborn. Represents the majority of births across the world.
  • Indications
    • Spontaneous labor mediated by hormone cascade or induction; rupture of amniotic/chorionic membranes.
  • Contraindications
    • Prolapsed cord, face/breech presentation, abnormal fetal heart patterns (bradycardia/tachycardia)
  • Complications
    • Premature rupture of membranes, failure to progress, postpartum hemorrhage
Video Credit: Global Health Media Project

*Deep Dive: Emergency Delivery (International Emergency Medicine Education Project)

Resuscitative Hysterotomy

  • Background
    • Previously known as “perimortem cesarean section”. Involves delivering a fetus from a gravid mother through an abdominal incision during or after maternal cardiopulmonary arrest. Potentially life-saving for both the mother and the fetus.
  • Indications
    • Maternal cardiac arrest w/o ROSC within 4 minutes
  • Contraindications
    • Gestational age < 24 weeks, ROSC within 4 minutes
  • Complications
    • Fetal injury, hemorrhagic shock
Video Credit: EEM

*Deep Dive: Perimortem C-Section (EM Cases)

Shoulder Dystocia Management

  • Background
    • Shoulder dystocia occurs when one or both shoulders become impacted against the bones of the maternal pelvis, preventing vaginal delivery. Management techniques include the McRobert’s, Rubin, Jacquemier, and Woods maneuvers.
  • Indications
    • Any clinically significant shoulder dystocia
  • Contraindications
    • Fundal pressure, strong lateral traction, and head rotation beyond 90 degrees should be avoided.
  • Complications
    • Clavicle fracture, brachial plexus injury
Video Credit: Merck Manuals

*Deep Dive: Shoulder Dystocia (Core EM)

Brandon Simpson, PA-C
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