Behind the Knife ABSITE 2026: Obstetrics & Gynecology Review

Female Reproductive Organ Ligaments

• 📌 The broad ligament extends from the uterus to the pelvic side walls, housing the uterine artery and vein.
• 📌 The round ligament travels from the uterus through the inguinal canal to the labia majora.
• 📌 The suspensory ligament connects the ovary to the pelvic sidewall and contains the ovarian artery and vein.

Physiological Changes During Pregnancy

• 🤰 Cardiovascular changes include dilutional anemia, leukocytosis, thrombocytosis, and increased clotting factors.
• 🫁 Respiratory system changes involve increased tidal volume, decreased functional residual capacity, and a chronic compensated respiratory alkalosis.
• 🤢 The GI tract experiences decreased motility, reduced esophageal sphincter competency, and an increased aspiration risk.

Ectopic Pregnancy Management

• ⚠️ The leading cause of first-trimester mortality is ectopic pregnancy, with risk factors including PID, prior ectopic pregnancy, IUD use, and smoking.
• 🩸 Management options include non-operative (methotrexate for hemodynamically stable patients with low beta-HCG and no fetal cardiac activity) or operative (salpingostomy or salpingectomy).
• 🏥 Transvaginal ultrasound is the primary imaging modality, and Rh-negative mothers require RhoGAM within 72 hours of presumed rupture.

Surgery and Anesthesia in Pregnant Patients

• ⚠️ Medically necessary surgeries should be performed, as no currently used anesthesia agents are associated with teratogenicity, though preterm delivery risk should be considered.
• 🤰 Laparoscopic surgery can be safely performed in all trimesters, with port placement adjusted for gravid uterus size.
• 🏥 Common non-obstetric surgical indications include appendicitis and cholecystitis.

Trauma in Pregnant Patients

• 🚨 In trauma, prioritize the mother's well-being ("what's good for mom is good for baby"), proceeding with surveys and imaging as indicated.
• 📈 Fetal viability is typically considered at 24 weeks, with continuous monitoring for fetuses over this age.
• ⚠️ Left-sided patient tilt can improve venous return in unstable patients, and Rh-negative status requires RhoGAM.

Benign Gynecologic Conditions

• 🌸 Endometriosis presents with dysmenorrhea, dyspareunia, and infertility, often visualized as blue-tinged masses on laparoscopy; treatment includes oral contraceptives or surgical excision.
• 🦠 Pelvic inflammatory disease (PID) symptoms include fever, discharge, and cervical motion tenderness, managed with broad-spectrum antibiotics and potentially drainage for abscesses.

Gynecologic Malignancies

• ⚠️ Ovarian cysts with thick septations, solid components, papillary projections, or significant vascularity are suspicious for malignancy.
• 🎗️ Ovarian cancer risk factors include nulliparity, late menopause, and family history; protective factors include OCP use and prior pregnancies.
• 🩸 Endometrial cancer is associated with unopposed estrogen, obesity, and tamoxifen use, typically presenting as post-menopausal bleeding, diagnosed via ultrasound and biopsy.
• 📈 Cervical cancer first spreads to the obturator nodes.

Quick Hits

• 📍 The most common site for endometriosis is the ovaries, followed by uterosacral ligaments and the pouch of Douglas.
• 📍 The most common site for ectopic pregnancy is the fallopian tube.
• 📍 Postpartum hepatic vein and IVC thrombosis can present with liver failure and ascites, treated with heparin.
• 📍 Contraindications to estrogen therapy include a history of endometrial or breast cancer and unknown uterine bleeding.
• 📍 The most common complication of laparoscopic hysterectomy is bladder injury, while the most common site of ureteral injury is the distal ureter at the uterine arteries.
• 📍 Endometrial cancer is the most common gynecologic malignancy, while ovarian cancer is the leading cause of death.
• 📍 A Krukenberg tumor is a stomach cancer metastasis to the ovary, characterized by signet ring cells.
• 📍 Meigs syndrome involves an ovarian fibroma causing ascites and hydrothorax, treated by excising the fibroma.
• 📍 The most common extracolonic tumor in Lynch syndrome is endometrial cancer.