Obgy common opd cases with proper drug doses and frequency
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Now I have rich, detailed information from the textbooks. Let me compile the comprehensive OBGyn OPD guide.
Common OBGyn OPD Cases - Drug Doses & Frequency
1. DYSMENORRHEA (Primary / Secondary)
First-line: NSAIDs - Start 1-2 days before expected menses, continue 2-3 days
| Drug | Dose | Frequency |
|---|---|---|
| Ibuprofen | 400-600 mg | TID with food |
| Mefenamic acid | 500 mg loading, then 250 mg | Q6-8h (max 3 days) |
| Naproxen | 500 mg loading, then 250 mg | BD |
| Nimesulide | 100 mg | BD |
Second-line: Hormonal
- Combined Oral Contraceptive (COC) pill - cyclic or continuous
- Progestin-only pill (norethisterone 5 mg TID from day 15-25 of cycle)
- Levonorgestrel IUD (long-term option)
Add-on for spasm relief:
- Hyoscine butylbromide (Buscopan) 10 mg TDS as needed
Source: Harrison's Principles of Internal Medicine 22E; Berek & Novak's Gynecology
2. ABNORMAL UTERINE BLEEDING (AUB) / MENORRHAGIA
Acute heavy bleeding:
| Drug | Dose | Frequency | Duration |
|---|---|---|---|
| Tranexamic acid | 500-1000 mg | TID | Days 1-5 of menses |
| Norethisterone (progestin) | 5 mg | TID | Until bleeding stops, then taper |
| COC pill (high-dose) | 1 tab | TDS for 3 days, then BD x 3, then OD | Cycling down |
Long-term / Chronic AUB:
| Drug | Dose | Frequency |
|---|---|---|
| Medroxyprogesterone acetate (MPA) | 10 mg/day | Day 15-26 of cycle |
| Norethisterone | 5 mg | BD from day 15-25 |
| Low-dose COC pill | 1 tab | Daily (cyclic) |
| Mefenamic acid | 500 mg | BD-TID during menses (reduces flow 30-50%) |
| Levonorgestrel IUD | Insert once | Effective for 5 years |
Source: Berek & Novak's Gynecology, p.445-446
3. VAGINAL DISCHARGE / VAGINITIS
A. Bacterial Vaginosis (BV)
Clue cells on wet mount, pH >4.5, fishy odor, white-grey discharge
| Drug | Dose | Frequency | Duration |
|---|---|---|---|
| Metronidazole | 500 mg | BD | 7 days |
| Metronidazole gel 0.75% | 5g intravaginally | OD at night | 5 days |
| Clindamycin 2% vaginal cream | 5g intravaginally | OD at night | 7 days |
| Clindamycin (oral) | 300 mg | BD | 7 days |
B. Vulvovaginal Candidiasis (VVC)
Thick white curdy discharge, vulval pruritus, pH normal 4.0-4.5
| Drug | Dose | Frequency | Duration |
|---|---|---|---|
| Fluconazole (oral) | 150 mg | Single dose | Once |
| Clotrimazole vaginal tablet | 100 mg | OD intravaginally | 6 nights |
| Clotrimazole 1% cream | Apply topically | BD | 7 days |
| Miconazole 2% vaginal cream | 5g intravaginally | OD at night | 7 days |
Recurrent VVC (>4 episodes/year): Fluconazole 150 mg weekly for 6 months
C. Trichomonas vaginalis
Frothy, yellow-green, malodorous discharge; strawberry cervix
| Drug | Dose | Frequency |
|---|---|---|
| Metronidazole | 2 g | Single oral dose (treat partner too) |
| Tinidazole | 2 g | Single oral dose |
| Alternative: Metronidazole | 500 mg | BD x 7 days |
Source: Rosen's Emergency Medicine; Schwartz's Principles of Surgery; Jawetz Medical Microbiology
4. UTI IN PREGNANCY (Asymptomatic Bacteriuria / Cystitis)
Screen all pregnant women at 12-16 weeks with urine culture
| Drug | Dose | Frequency | Duration |
|---|---|---|---|
| Cephalexin | 500 mg | BD | 3-7 days |
| Nitrofurantoin | 100 mg | BD | 3-7 days (avoid in 3rd trimester) |
| Amoxicillin | 500 mg | TID | 7 days |
| Co-trimoxazole (TMP-SMX) | 800/160 mg | BD | 3 days (avoid in 3rd trimester) |
Pyelonephritis in pregnancy: Hospital admission, IV Ceftriaxone 1g daily
Source: Rosen's Emergency Medicine, p. 3367
5. ANTENATAL CARE (ANC) - Routine Supplements
| Drug | Dose | Frequency | When |
|---|---|---|---|
| Folic acid | 5 mg (high risk) / 400 mcg (routine) | OD | Pre-conception - 12 weeks |
| Elemental Iron | 60 mg (ferrous sulfate 200 mg) | OD-BD | Throughout pregnancy |
| Calcium carbonate | 500-1000 mg | BD | 2nd trimester onwards |
| Vitamin D | 400-1000 IU | OD | Throughout |
| Aspirin (low-dose) | 75-150 mg | OD at night | 12-36 wks (high risk for preeclampsia) |
| Tetanus toxoid | 0.5 ml IM | 2 doses (4 wk apart) | 1st pregnancy / booster |
6. POLYCYSTIC OVARIAN SYNDROME (PCOS)
Irregular cycles, anovulation, hyperandrogenism, insulin resistance
| Indication | Drug | Dose | Frequency |
|---|---|---|---|
| Cycle regulation | Cyclic progestin (MPA) | 10 mg/day | Day 14-26 monthly |
| Cycle regulation | COC pill | 1 tab | Daily (cyclic) |
| Hirsutism | Spironolactone | 50-100 mg | OD-BD |
| Insulin resistance | Metformin | 500 mg (start), up to 1500 mg | BD-TID with food |
| Ovulation induction | Clomiphene citrate | 50-150 mg | Day 2-6 of cycle (under supervision) |
7. HYPOTHYROIDISM IN PREGNANCY
| Drug | Dose | Frequency |
|---|---|---|
| Levothyroxine (T4) | 1.6 mcg/kg/day | OD on empty stomach |
TSH target in pregnancy: 0.1-2.5 mIU/L (1st trimester), 0.2-3.0 mIU/L (2nd/3rd)
Dose often needs 20-30% increase in early pregnancy
8. HYPERTHYROIDISM IN PREGNANCY
| Drug | Dose | Frequency | Notes |
|---|---|---|---|
| Propylthiouracil (PTU) | 100-150 mg | TDS | Preferred in 1st trimester |
| Carbimazole / Methimazole | 5-20 mg | OD-BD | 2nd/3rd trimester preferred |
| Propranolol | 20-40 mg | BD-TDS | For symptom control (short-term) |
9. PREECLAMPSIA / HYPERTENSION IN PREGNANCY
| Indication | Drug | Dose | Frequency |
|---|---|---|---|
| Mild HTN (BP 140-159/90-109) | Methyldopa | 250 mg | TDS-QID (max 3g/day) |
| Mild HTN | Labetalol | 100-200 mg | BD-TID |
| Mild HTN | Nifedipine (extended release) | 30-60 mg | OD |
| Severe HTN (>160/110) | IV Labetalol | 20 mg IV bolus, repeat Q10 min | Max 300 mg total |
| Severe HTN (acute) | Nifedipine (immediate release) | 10 mg oral | Q20-30 min |
| Eclampsia / Seizure prophylaxis | Magnesium sulfate | 4g IV loading, then 1-2g/hr maintenance | Continue 24 hrs postpartum |
10. ENDOMETRIOSIS
| Line | Drug | Dose | Frequency | Duration |
|---|---|---|---|---|
| 1st | COC pill (continuous) | 1 tab | OD continuously | 3-6 months |
| 1st | Norethisterone | 5 mg | BD-TID | Continuous |
| 2nd | Levonorgestrel IUD | Insert | - | 5 years |
| 3rd | GnRH agonist (Leuprolide) | 3.75 mg IM | Monthly | Max 6 months |
| 3rd | Add-back therapy with GnRH agonist | Norethindrone 5 mg | OD | With GnRH agonist |
| 3rd | Aromatase inhibitor (Letrozole) | 2.5 mg | OD | Specialist supervision |
Source: Harrison's Principles of Internal Medicine 22E; Berek & Novak's Gynecology
11. URINARY TRACT INFECTION (Non-pregnant)
| Drug | Dose | Frequency | Duration |
|---|---|---|---|
| Nitrofurantoin | 100 mg | BD | 5-7 days |
| Co-trimoxazole | 960 mg | BD | 3 days |
| Ciprofloxacin | 500 mg | BD | 3 days |
| Cephalexin | 500 mg | BD | 5-7 days |
| Fosfomycin trometamol | 3g | Single sachet in water | Once |
12. PELVIC INFLAMMATORY DISEASE (PID)
Lower abdominal pain, vaginal discharge, cervical motion tenderness
Outpatient (mild-moderate):
| Drug | Dose | Frequency | Duration |
|---|---|---|---|
| Ceftriaxone | 500 mg IM | Single dose | Once |
| + Doxycycline | 100 mg | BD | 14 days |
| + Metronidazole | 400-500 mg | BD | 14 days |
Alternative oral regimen:
| Drug | Dose | Frequency | Duration |
|---|---|---|---|
| Ofloxacin | 400 mg | BD | 14 days |
| + Metronidazole | 400 mg | BD | 14 days |
Key Prescribing Notes
- NSAIDs: Always give with food, avoid in peptic ulcer disease and renal impairment
- Metronidazole: Avoid alcohol during treatment; can be used in 2nd/3rd trimester of pregnancy
- COC pills: Contraindicated in smokers >35 years, history of thromboembolism, migraine with aura
- Magnesium sulfate: Monitor urine output (>30 mL/hr), respiratory rate (>12/min), and patellar reflexes; keep calcium gluconate antidote ready
- Folic acid: High dose (5 mg) for patients on antiepileptics, previous NTD history, diabetes, or BMI >30
- Levothyroxine: Take 30-60 min before breakfast; avoid concurrent iron/calcium supplements
Sources: Berek & Novak's Gynecology (9781496380357) | Harrison's Principles of Internal Medicine 22E | Rosen's Emergency Medicine | Schwartz's Principles of Surgery
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Recent Clinical Guidelines in Obstetrics & Gynecology (2023-2026)
Here is a curated, topic-organized summary of the most current guidelines from ACOG, ESHRE, ESGO, WHO, ATA, and other major bodies - all published within the last 3 years and retrieved from PubMed.
OBSTETRICS
1. Labor Management
ACOG Clinical Practice Guideline No. 8 - First and Second Stage Labor Management (2024)
[PMID: 38096556] - Obstetrics & Gynecology
- Defines labor arrest criteria and management of dystocia in both stages
- Provides GRADE-classified recommendations for oxytocin augmentation, amniotomy, and operative delivery thresholds
- Replaces older definitions of "active phase" - latent phase now extends up to 6 cm dilation
- Nulliparous: 2nd stage arrest if no progress for ≥3 hours (without epidural) or ≥4 hours (with epidural)
- Key update: encourages a more patient and labor-supportive approach before resorting to cesarean
2. Intrapartum Fetal Monitoring
ACOG Clinical Practice Guideline No. 10 - Intrapartum Fetal Heart Rate Monitoring (2025)
[PMID: 40966736] - Obstetrics & Gynecology, October 2025
- Updated three-tier classification system (Category I, II, III) with clearer management pathways
- Replaces two older Practice Bulletins (#106, #116) and a 2022 Practice Advisory on oxygen supplementation
- New guidance on intrauterine resuscitation maneuvers, scalp stimulation, and operative delivery thresholds for FHR abnormalities
3. Cervical Ripening / Induction of Labor
ACOG Clinical Practice Guideline No. 9 - Cervical Ripening in Pregnancy (2025)
[PMID per ACOG website, June 2025]
- Replaces Practice Bulletin #107 (2009)
- Covers pharmacologic (prostaglandins - dinoprostone, misoprostol), mechanical (balloon catheters, laminaria), and combination methods
- Applies to term singleton vertex pregnancies with intact membranes
- Recommendations classified by strength and evidence quality
4. Hypertensive Disorders in Pregnancy
SOMANZ Hypertension in Pregnancy Guideline 2023 (Summary published 2024)
[PMID: 38763516] - Medical Journal of Australia
Key updated recommendations (39 total):
- Combined first-trimester screening (mean arterial pressure + PIGF + uterine artery Doppler) to identify preeclampsia risk
- Low-dose aspirin 100-150 mg/day from 12-16 weeks - strongly recommended for high-risk women identified by first-trimester screening
- Antihypertensive target: <140/90 mmHg (treatment threshold lowered from prior guidelines)
- Acute severe hypertension (≥160/110): IV labetalol or oral nifedipine as first-line; magnesium sulfate for seizure prophylaxis
- New inclusion of angiogenic biomarkers (sFlt-1/PlGF ratio) for ruling out preeclampsia in suspected cases
- Long-term cardiovascular follow-up recommended for women who experienced HDP
5. Postpartum Hemorrhage
WHO Consolidated Guidelines on PPH Prevention, Diagnosis and Treatment (2024-2025)
[Source: WHO/NCBI Bookshelf NBK619236]
- 51 total recommendations; 20 are new or updated (from 2024-2025 GDG process)
- Oxytocin 10 IU IM remains the preferred uterotonic for prevention
- Tranexamic acid 1g IV (within 3 hours of birth onset) recommended as adjunct treatment - now also considered early in prevention for high-risk women
- Carbetocin preferred over oxytocin in settings where cold chain is unavailable
- Uterine balloon tamponade for refractory PPH when surgery is unavailable
- Surgical: uterine compression sutures, systematic devascularization, hysterectomy as escalating steps
6. Thyroid Disease in Pregnancy
American Thyroid Association (ATA) 2026 Guidelines - Thyroid Disease in Preconception, Pregnancy, and Postpartum
[PMID: 42219800] - Thyroid, May 2026
Major updates from 2017 guidelines:
- Hypothyroidism: TSH targets narrowed - <2.5 mIU/L in 1st trimester, <3.0 in 2nd/3rd; levothyroxine dose increase of ~25-30% as soon as pregnancy confirmed
- Subclinical hypothyroidism: Treatment recommended when TSH >4 mIU/L with TPO antibodies positive, or TSH >10 mIU/L regardless
- Hyperthyroidism (Graves'): PTU preferred in 1st trimester (due to methimazole teratogenicity); switch to methimazole after 16 weeks
- Iodine supplementation: 150 mcg/day recommended throughout pregnancy and lactation
- Postpartum thyroiditis: 25% progress to permanent hypothyroidism - long-term follow-up recommended
7. Antiseizure Medications in Pregnancy
AAN/AES/SMFM Practice Guideline - Teratogenesis and Neurodevelopmental Outcomes After In Utero Antiseizure Medication Exposure (2024)
[PMID: 38748979] - Neurology, June 2024
- Valproate: AVOID in pregnancy (highest teratogenic risk - NTDs, cognitive delay, autism); only use if no alternative
- Lamotrigine and levetiracetam: preferred agents (lowest teratogenicity risk)
- All epileptic women of reproductive age: high-dose folic acid 5 mg/day pre-conception and in 1st trimester
- Recommends neurology-obstetrics co-management
8. Perinatal Mood Disorders
CANMAT 2024 Clinical Practice Guideline - Perinatal Mood, Anxiety, and Related Disorders
[PMID: 39936923] - Canadian Journal of Psychiatry, 2025
- Screening: Edinburgh Postnatal Depression Scale (EPDS) recommended at each trimester and at 6 weeks postpartum
- SSRIs (sertraline, escitalopram): First-line for perinatal depression and anxiety
- Brexanolone IV (zuranolone oral in US): approved specifically for postpartum depression - significant advance
- CBT and interpersonal therapy: evidence-based non-pharmacological options
- Discontinuation of antidepressants in pregnancy not routinely recommended
9. Viral Hepatitis in Pregnancy
ACOG Clinical Practice Guideline No. 6 - Viral Hepatitis in Pregnancy (2023)
[PMID: 37590986] - Obstetrics & Gynecology, September 2023
- Universal HBsAg screening at first prenatal visit
- HBV DNA >200,000 IU/mL at 28 weeks: add tenofovir disoproxil fumarate to prevent vertical transmission
- Hepatitis C: universal screening recommended; DAAs (direct-acting antivirals) not currently recommended in pregnancy due to insufficient safety data - treat postpartum
- Hepatitis A vaccination safe and recommended in pregnancy if indicated
GYNECOLOGY
10. Polycystic Ovary Syndrome (PCOS)
International Evidence-Based Guideline for PCOS Assessment and Management (2023 Update)
[PMID: 37580861] - European Journal of Endocrinology, August 2023
Joint: ESHRE, ASRM, and 39 professional organizations across 71 countries; 254 recommendations
Key updates:
- Diagnosis: Now requires only ONE elevated FSH (>25 IU/L) to diagnose POI component; anti-Müllerian hormone (AMH) can replace ultrasound for ovarian morphology assessment in adults
- Metabolic screening: Expanded - all PCOS women should be screened for metabolic syndrome, sleep apnoea, cardiovascular risk
- Lifestyle: First-line for all - weight loss (≥5-10% body weight) improves menstrual cyclicity and fertility
- Insulin sensitizers: Metformin 500-1500 mg/day - recommended for metabolic features, cycle regulation, and ovulation induction adjunct
- Cycle regulation: Combined OCP preferred; inositol (myo-inositol 2g BD) emerging as an option
- Infertility/ovulation induction: Letrozole 2.5-5 mg on days 3-7 is NOW preferred over clomiphene citrate as 1st-line agent
- Psychological features: Very high prevalence (depression, anxiety) - screen and treat proactively
11. Premenstrual Disorders (PMS / PMDD)
ACOG Clinical Practice Guideline No. 7 - Management of Premenstrual Disorders (2023)
[PMID: 37973069] - Obstetrics & Gynecology, December 2023
Key recommendations:
| Treatment | Dose | Evidence |
|---|---|---|
| SSRIs (sertraline, fluoxetine) - continuous or luteal phase | Sertraline 50-150 mg/day | Strong |
| COC pill (drospirenone-based preferred) | 1 tab daily | Moderate |
| Calcium supplementation | 1200 mg/day | Moderate |
| Vitamin B6 | 50-100 mg/day | Weak |
| Aerobic exercise | 30 min, 3-5x/week | Moderate |
| CBT/psychotherapy | - | Strong |
| GnRH agonist (severe/refractory) | Leuprolide 3.75 mg/month + add-back HRT | Specialist use |
- Surgical (bilateral oophorectomy): only for severe, treatment-refractory PMDD after all options exhausted
12. Endometriosis - Diagnosis
ACOG Clinical Practice Guideline - Diagnosis of Endometriosis (2026)
[PMID: 41712950] - Obstetrics & Gynecology, March 2026
- Clinical diagnosis acceptable when symptoms are classic (cyclic dysmenorrhea, deep dyspareunia, dyschezia, infertility)
- Transvaginal ultrasound: first-line imaging for ovarian endometrioma and deep infiltrating endometriosis
- CA-125 NOT recommended as a diagnostic tool (low specificity)
- Pelvic MRI: superior for deep infiltrating endometriosis mapping (rectovaginal, bladder nodules)
- Diagnostic laparoscopy: gold standard but no longer required before starting empirical medical treatment
- Empirical treatment with hormonal therapy (COC, progestins) is appropriate without confirmed histological diagnosis when clinical suspicion is high
13. Premature Ovarian Insufficiency (POI)
ESHRE/ASRM/IMS Evidence-Based Guideline on POI (2024)
[PMID: 39647506] - Climacteric, December 2024
- Revised diagnostic threshold: only ONE elevated FSH >25 IU/L required (previously two measurements required >3 months apart)
- AMH may assist in diagnosing uncertain cases
- Hormone Therapy (HRT): Strongly recommended until at least age 50 - protects bone, cardiovascular, and cognitive health; does NOT carry same risks as HRT in post-menopausal women
- Estrogen: transdermal preferred (safer cardiovascular profile); combined with cyclical progestogen if uterus intact
- Testosterone: consider for sexual dysfunction/libido if HRT alone insufficient
- Fertility: 5-10% spontaneous pregnancy possible; refer for fertility counseling/oocyte donation early
14. Gynecologic Oncology - Fertility Sparing
ESGO/ESHRE/ESGE Guidelines - Fertility-Sparing Treatment in Cervical, Ovarian Cancer, and Borderline Tumors (2024)
[PMID: 39216500] - Lancet Oncology, November 2024
- Cervical cancer (stage IA1-IB1): Cone biopsy or radical trachelectomy (laparoscopic/vaginal/abdominal) are acceptable fertility-sparing options; margins must be clear
- Ovarian cancer (stage IA, grade 1-2): Unilateral salpingo-oophorectomy + comprehensive staging with preservation of contralateral ovary and uterus
- Borderline ovarian tumors: Cystectomy preferred over oophorectomy to preserve fertility, with careful staging
- Endometrial cancer (grade 1, stage IA, no myometrial invasion): Levonorgestrel IUD + oral progestins (megestrol acetate or MPA) - close surveillance with endometrial biopsy Q3-6 months
15. Endometrial Carcinoma
ESGO-ESTRO-ESP Guidelines for Endometrial Carcinoma: Update 2025
[PMID: 40744042] - Lancet Oncology, 2025
- Molecular classification now integrated into risk stratification: POLE-mutated (excellent prognosis), MMR-deficient, p53-mutated (worst prognosis)
- Adjuvant treatment stratified by molecular subtype, not just FIGO stage
- Immunotherapy (pembrolizumab): now recommended for MMR-deficient/MSI-high advanced/recurrent disease
Quick Reference: Guideline Sources
| Organization | Full Name | Website |
|---|---|---|
| ACOG | American College of Obstetricians and Gynecologists | acog.org |
| ESHRE | European Society of Human Reproduction and Embryology | eshre.eu |
| ESGO | European Society of Gynaecological Oncology | esgo.org |
| WHO | World Health Organization | who.int |
| ATA | American Thyroid Association | thyroid.org |
| SOMANZ | Society of Obstetric Medicine Australia & New Zealand | somanz.org |
| RCOG | Royal College of Obstetricians & Gynaecologists | rcog.org.uk |
2025-2026 ACOG Clinical Practice Guidelines - Summary Timeline
| No. | Topic | Year |
|---|---|---|
| CPG #6 | Viral Hepatitis in Pregnancy | 2023 |
| CPG #7 | Premenstrual Disorders | 2023 |
| CPG #8 | First & Second Stage Labor Management | 2024 |
| CPG #9 | Cervical Ripening in Pregnancy | 2025 |
| CPG #10 | Intrapartum Fetal Heart Rate Monitoring | 2025 |
| CPG #11 | Diagnosis of Endometriosis | 2026 |
Note: All PMIDs are verified on PubMed as of June 2026. Access to full ACOG Clinical Practice Guidelines requires an ACOG membership or Obstetrics & Gynecology journal subscription. WHO guidelines are freely accessible at who.int.
Generate a comparison table of first-line vs second-line treatments
Based on everything we've covered in this session (common OBGyn OPD cases + recent guidelines), here is a comprehensive comparison table:
First-Line vs Second-Line Treatments: Common OBGyn Conditions
GYNECOLOGY
| Condition | First-Line Treatment | Dose & Frequency | Second-Line Treatment | Dose & Frequency | Notes |
|---|---|---|---|---|---|
| Primary Dysmenorrhea | NSAIDs (Ibuprofen / Mefenamic acid) | Ibuprofen 400-600 mg TID; Mefenamic 500 mg load → 250 mg Q8h | Combined OCP (cyclic or continuous) | 1 tab OD | Start NSAIDs 1-2 days before expected menses |
| Dysmenorrhea (refractory) | Progestin-only pill / Levonorgestrel IUD | Norethisterone 5 mg BD-TID | GnRH agonist (Leuprolide) + add-back therapy | 3.75 mg IM monthly | Add-back: norethindrone 5 mg OD |
| AUB / Menorrhagia (acute) | Tranexamic acid | 1g TID, days 1-5 of menses | High-dose progestin (Norethisterone) | 5 mg TID until bleeding stops, then taper | Tranexamic acid reduces flow by ~50% |
| AUB / Menorrhagia (chronic) | Combined OCP or cyclic progestin | MPA 10 mg/day, days 15-26 OR low-dose COC daily | Levonorgestrel IUD | Insert once, effective 5 years | LNG-IUD preferred before hysterectomy (ACOG) |
| Bacterial Vaginosis | Metronidazole oral | 500 mg BD x 7 days | Clindamycin vaginal cream 2% | 5g intravaginally OD x 7 nights | Treat partner only if symptomatic |
| Vulvovaginal Candidiasis | Fluconazole oral (single dose) | 150 mg once | Clotrimazole pessary 100 mg | OD intravaginally x 6 nights | Recurrent (>4/year): fluconazole 150 mg weekly x 6 months |
| Trichomoniasis | Metronidazole 2g single dose | 2g oral, once | Tinidazole 2g single dose OR metronidazole 500 mg BD x 7 days | 2g once OR 500 mg BD | Always treat partner simultaneously |
| PCOS - Cycle regulation | Combined OCP (drospirenone-based preferred) | 1 tab OD (cyclic) | Cyclic progestin (MPA) OR Myo-inositol | MPA 10 mg x 12 days/month; Inositol 2g BD | 2023 ESHRE/ASRM international guideline |
| PCOS - Metabolic / IR | Lifestyle modification (diet + exercise) | Weight loss ≥5-10% body weight | Metformin | 500 mg OD titrate to 1000-1500 mg/day | First pharmacologic option for IR/metabolic features |
| PCOS - Ovulation induction | Letrozole | 2.5-5 mg, days 3-7 of cycle | Clomiphene citrate | 50-150 mg, days 2-6 | Letrozole now preferred over clomiphene - 2023 ESHRE/ASRM guideline |
| Endometriosis (pain) | NSAIDs + Combined OCP (continuous) | Ibuprofen 400 mg TID + OCP 1 tab OD | Progestins continuous (Norethisterone / Dienogest) | Norethisterone 5 mg BD; Dienogest 2 mg OD | Empirical treatment without laparoscopy is acceptable - ACOG 2026 |
| Endometriosis (refractory) | Levonorgestrel IUD | Insert, effective 5 years | GnRH agonist + add-back HRT | Leuprolide 3.75 mg IM monthly + norethindrone 5 mg OD | Max 6 months; add-back prevents bone loss |
| PMS / PMDD | SSRIs (Sertraline) - continuous or luteal phase | 50-150 mg/day or day 14-menses | Combined OCP (drospirenone 3 mg + EE 20 mcg) | 1 tab OD x 24 active days | ACOG CPG No. 7, 2023 |
| PMS / PMDD - refractory | Calcium 1200 mg/day + aerobic exercise | OD supplement; 30 min x 3-5/week | GnRH agonist ± surgical oophorectomy | Specialist use only | Oophorectomy: last resort for severe PMDD |
| Premature Ovarian Insufficiency (POI) | HRT - transdermal estrogen + cyclic progestogen | E2 patch 50-100 mcg/day + MPA 10 mg x 12 days/month | Combined OCP (if HRT not preferred/available) | 1 tab OD | Continue until at least age 50 - ESHRE 2024 guideline |
| UTI (non-pregnant) | Nitrofurantoin OR Fosfomycin | Nitrofurantoin 100 mg BD x 5-7 days; Fosfomycin 3g sachet once | Co-trimoxazole (TMP-SMX) OR Ciprofloxacin | TMP-SMX 960 mg BD x 3 days; Cipro 500 mg BD x 3 days | Choice based on local antibiogram |
| PID (outpatient) | Ceftriaxone IM + Doxycycline + Metronidazole | Ceftriaxone 500 mg IM once + Doxy 100 mg BD x 14 days + Metro 400 mg BD x 14 days | Ofloxacin + Metronidazole | Ofloxacin 400 mg BD + Metro 400 mg BD x 14 days | Avoid fluoroquinolones if gonorrhea resistance high locally |
OBSTETRICS
| Condition | First-Line Treatment | Dose & Frequency | Second-Line Treatment | Dose & Frequency | Notes |
|---|---|---|---|---|---|
| Iron Deficiency Anemia (pregnancy) | Oral ferrous sulfate | 200 mg (60 mg elemental iron) BD | IV iron sucrose / ferric carboxymaltose | IV iron sucrose 200 mg in 100 mL NS over 30 min | IV if Hb <7 g/dL or intolerance to oral |
| Gestational Hypertension / Mild preeclampsia | Methyldopa | 250-500 mg TID (max 3g/day) | Labetalol OR Nifedipine ER | Labetalol 100-200 mg BD-TID; Nifedipine ER 30-60 mg OD | Methyldopa: avoid in depression; target BP <140/90 |
| Severe Hypertension in pregnancy (≥160/110) | IV Labetalol | 20 mg IV bolus, repeat Q10 min (max 300 mg) | Oral Nifedipine (immediate release) | 10 mg oral Q20-30 min (max 3 doses) | SOMANZ 2023 guideline |
| Eclampsia / Seizure prophylaxis | Magnesium sulfate | 4g IV loading over 20 min, then 1-2g/hr x 24 hours | Phenytoin (rarely used now) | 15-20 mg/kg IV | MgSO4 antidote: Calcium gluconate 1g IV slow |
| Gestational Diabetes (diet-controlled) | Medical nutrition therapy + exercise | Low GI diet; 30 min moderate exercise OD | Metformin | 500 mg OD titrate to 1000-2000 mg/day | ACOG: delivery by 40+6 wks if diet-controlled |
| Gestational Diabetes (medication-required) | Insulin (NPH + regular / basal-bolus) | Per glucose monitoring protocol | Metformin (if insulin declined/unavailable) | 500-2000 mg/day in divided doses | Insulin: gold standard in pregnancy; ACOG delivery 39-39+6 wks |
| Nausea & Vomiting of Pregnancy (mild) | Ginger + Pyridoxine (B6) | Ginger 250 mg QID; B6 10-25 mg TDS | Doxylamine + B6 (Diclegis) | Doxylamine 10 mg + B6 10 mg, 2 tabs at night | ACOG first-line; take on empty stomach |
| Hyperemesis Gravidarum | IV fluids + Promethazine or Metoclopramide | NS/RL rehydration; Promethazine 25 mg IM/IV Q6h | Ondansetron 4-8 mg IV/oral Q8h | 4-8 mg Q8h | Reserve ondansetron for refractory cases (cardiac QT risk) |
| UTI in Pregnancy | Cephalexin OR Nitrofurantoin | Cephalexin 500 mg BD x 7 days; Nitrofurantoin 100 mg BD x 5-7 days | Amoxicillin 500 mg TID x 7 days | Based on culture sensitivity | Avoid nitrofurantoin in 3rd trimester (hemolytic risk) |
| Preterm Labor (tocolysis) | Nifedipine | 20 mg loading then 10-20 mg Q4-6h x 48 hrs | Indomethacin (< 32 weeks only) | 50-100 mg rectal/oral load, then 25-50 mg Q6h | Use tocolytics to allow corticosteroids to work (48-hr window) |
| Fetal Lung Maturity (24-34 weeks) | Betamethasone | 12 mg IM x 2 doses, 24 hrs apart | Dexamethasone | 6 mg IM Q12h x 4 doses | Single rescue course if < 34 wks, >14 days after 1st course |
| GBS Prophylaxis in Labor | IV Penicillin G | 5 MU IV load, then 2.5 MU Q4h until delivery | IV Ampicillin (if PCN unavailable) | 2g IV load, then 1g Q4h | If PCN allergy (anaphylaxis risk): Clindamycin or Vancomycin |
| PPH Prevention (3rd stage) | Oxytocin IM | 10 IU IM after delivery of anterior shoulder | Carbetocin (if cold chain unavailable) | 100 mcg IM single dose | WHO 2024-2025 consolidated PPH guidelines |
| PPH Treatment (active bleeding) | Oxytocin IV + uterine massage | 20-40 IU in 500 mL NS IV infusion | Tranexamic acid + Misoprostol | TXA 1g IV; Misoprostol 800 mcg sublingual | TXA within 3 hours of birth; WHO 2024 |
| Hypothyroidism in Pregnancy | Levothyroxine | 1.6 mcg/kg/day OD on empty stomach | Dose titration upward | +25-30% dose increase when pregnancy confirmed | ATA 2026 guidelines; TSH target <2.5 mIU/L in 1st trimester |
| Hyperthyroidism in Pregnancy (1st trimester) | Propylthiouracil (PTU) | 100-150 mg TDS | Methimazole (2nd/3rd trimester) | 5-20 mg OD-BD | Switch to methimazole after 16 weeks; ATA 2026 |
| Postpartum Depression | SSRI (Sertraline or Escitalopram) | Sertraline 50-150 mg OD | Zuranolone (oral) / Brexanolone (IV) | Zuranolone 50 mg OD x 14 days | CANMAT 2024; screen with EPDS at each trimester + 6 wks postpartum |
Surgical Escalation (when all medical lines fail)
| Condition | After Medical Failure |
|---|---|
| AUB / Menorrhagia | Endometrial ablation → Hysterectomy |
| Uterine fibroids | Myomectomy → UAE → Hysterectomy |
| Endometriosis | Laparoscopic excision/ablation → Hysterectomy + BSO |
| PMDD (severe) | Bilateral oophorectomy (last resort) |
| Ectopic pregnancy | Salpingotomy (fertility-sparing) → Salpingectomy |
| PPH (refractory) | Uterine compression sutures → Devascularization → Hysterectomy |
Key: OCP = oral contraceptive pill | MPA = medroxyprogesterone acetate | LNG-IUD = levonorgestrel IUD | TXA = tranexamic acid | ER = extended release | BD = twice daily | TID = three times daily | OD = once daily | IM = intramuscular | IV = intravenousSources: ACOG CPG #7, #8, #9, #10, #11 | ESHRE/ASRM PCOS 2023 | SOMANZ HDP 2023 | ATA 2026 | WHO PPH 2024-2025 | CANMAT 2024 | Berek & Novak's Gynecology | Harrison's Principles of Internal Medicine 22E
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OBGyn Quick Reference
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What's included in the PDF (3 pages, landscape A4):
| Page | Content |
|---|---|
| Page 1 | Gynaecology table - 16 conditions (Dysmenorrhea, AUB, Vaginitis, PCOS, Endometriosis, PMS/PMDD, POI, UTI, PID) |
| Page 2 | Obstetrics table - 17 conditions (Anaemia, Hypertension, Eclampsia, GDM, NVP, Preterm labour, GBS, PPH, Thyroid, PPD) |
| Page 3 | Surgical escalation ladder + Full abbreviations key + All guideline sources with PMIDs |
Design features for clinical use:
- Colour-coded section headers (teal for gynaecology, navy for obstetrics, orange for surgical escalation)
- Alternating row shading for quick scanning
- Every dose and frequency clearly separated
- Guideline source cited in the Notes column for each condition
- Footer disclaimer on every page
- Date-stamped generation date
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