OBG in a Minute by Dr. Anita

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OBG in a Minute | Dr Anita
MBBS DGO DNB FICOG
FMAS Diploma in Cosmetic / Aesthetic Gynecology & Functional Medicine
Faculty @ doc tutorials
📍 KIMS Cuddles | Guntur

28/03/2026

Aspirin Prophylaxis — Updated FOGSI Recommendations
Who should receive it?
High-risk mothers
Gestosis Score ≥3
Multiple moderate-risk factors
Dose:
75–150 mg, preferably 150 mg at bedtime
Start:
Between 12–16 weeks, latest by 20 weeks
Stop:
At 36 weeks
Why:
To reduce the incidence of:
Preeclampsia
Severe hypertension
Preterm birth
Fetal growth restriction
Evidence shows aspirin in high-Gestosis score mothers improves maternal–fetal outcomes significantly.

25/03/2026

The Gestosis Score is designed to identify the risk of developing hypertensive disorders, like preeclampsia, during pregnancy. Key takeaways from the video include:

When to Assess: It should ideally be applied during the first antenatal visit and repeated at every subsequent visit until 32 weeks, or at least once per trimester.

Assessment Factors: The score is calculated based on several criteria:

Maternal Characteristics: Age and BMI.

Medical History: Previous history of preeclampsia, chronic kidney conditions, and autoimmune disorders.

Clinical & Lab Parameters: Blood pressure readings and specific laboratory results.

Risk Levels:

Low Risk: A score between 1 and 2.

High Risk: A score of 3 or higher. High-risk cases usually require early aspirin prophylaxis and closer monitoring.

The ultimate goal of the Gestosis Score is to shift the medical approach from treatment to prevention, allowing doctors to predict and manage potential complications much earlier in the pregnancy.

Contact : 9908384060
anita.nelakuditi@gmail.com

















18/03/2026

RCOG 2024 Guidelines on Antenatal Steroids Explained!

The RCOG 2024 Update provides clear guidance on when a repeat course of corticosteroids is beneficial for the baby—and when it’s best avoided. Dr. Anita Nelakuditi breaks down the essentials in under a minute! 🩺✨

✅ When TO Repeat the Dose:
There is an ongoing risk of preterm birth.

It has been more than 7 days since the first course was administered.

Delivery is likely to occur within the next 7 days.

❌ When NOT to Repeat the Course:
Cases of severe growth restriction (with absent/reversed Doppler flows).

Presence of acute maternal infection or chorioamnionitis.

If delivery is not expected in the near future.
If the patient has already received multiple courses (more than 2).

12/03/2026

Updated Definitions (2026)
FOGSI emphasizes clarity & uniformity in diagnosing HDP:
✔ Chronic Hypertension
BP ≥140/90 mmHg before pregnancy or

07/03/2026

Hypertensive Disorders of Pregnancy (HDP) remain one of the leading causes of maternal morbidity and mortality in India.
The FOGSI Good Clinical Practice Recommendations 2026 introduce significant updates focusing on:
Early risk identification
The Gestosis Score
Refined definitions
Updated aspirin guidance
Structured multimodal screening
Practical monitoring and delivery planning.

Contact : 9908384060
anita.nelakuditi@gmail.com




01/03/2026

RCOG 2024 – “Do NOT use CTG alone for stillbirth reduction” (STRiDE Findings)
Perfect for PG teaching, OSCE, Insta content (“OBG in a Minute”), and clinical practice.
🔍 Why this update?
The STRiDE Study (Stillbirth Reduction Interventions & Data Evaluation) released new evidence reviewed by RCOG in 2024.
It showed that routine CTG (Cardiotocography) alone does NOT reduce stillbirth rates in low-risk or even many high-risk groups.
⭐ FULL EXPLANATION
1️⃣ CTG is excellent at detecting hypoxia… but terrible at predicting stillbirth
CTG detects current fetal oxygenation, not long-term placental insufficiency.
Stillbirth risk is driven by chronic placental problems like FGR, Doppler abnormalities, maternal disease.
CTG may be normal till very late → so it cannot serve as a screening tool.
2️⃣ STRiDE found: More CTGs = MORE interventions, NOT fewer stillbirths
Routine or frequent CTGs led to:
↑ Emergency LSCS
↑ Instrumental deliveries
↑ Unnecessary inductions
But no significant drop in stillbirth or neonatal morbidity.
Meaning: CTG increases action, not outcomes.
3️⃣ What does reduce stillbirth then?
The STRiDE analysis emphasises multimodal surveillance:
✔ Growth monitoring
Regular symphysio-fundal height
Timely ultrasound growth scans
Customised centiles
Doppler studies
✔ Maternal risk assessment
Hypertensive disease
Diabetes
Smoking/anaemia
Previous stillbirth
Reduced fetal movements
✔ Fetal Doppler studies
Umbilical artery
MCA
CPR (Cerebroplacental ratio)
These detect placental insufficiency, the MOST important stillbirth predictor.
✔ Timely delivery decisions
Deciding when to deliver a compromised fetus is more important than CTG frequency.
4️⃣ CTG should ONLY be used for what it is intended for
✔ Intrapartum monitoring
During labour in appropriate risk groups.
✔ Acute assessment
If reduced fetal movements / decelerations / suspected acute hypoxia.
Not for routine antenatal screening.
5️⃣ RCOG 2024 Key Message
**“CTG ALONE cannot reduce stillbirth.
Use integrated surveillance instead.”**
This means CTG must be part of a package—not the package itself.




25/02/2026

RELUGOLIX in Uterine Fibroid Management (2024–2025 Update)
(The GnRH antagonist that’s changing outpatient fibroid care)
🔍 WHAT IS RELUGOLIX?
A once-daily oral GnRH antagonist that suppresses ovarian estrogen production without flare (unlike GnRH agonists).
Most commonly used as a combination pill:
Relugolix + Estradiol + Norethindrone (Relugolix Combination Therapy – RCT)
– Better tolerated
– Prevents hypoestrogenic side effects
– Approved for heavy menstrual bleeding due to fibroids
⭐ MECHANISM – Simple for Reels
“Instant suppression — no flare.”
Blocks GnRH receptors → ↓ LH/FSH → ↓ estrogen
Fibroid vascularity + size ↓
Bleeding ↓ dramatically

Contact : 9908384060
anita.nelakuditi@gmail.com




18/02/2026

STOP starving women in labour — WHO has updated!
WHO Intrapartum Care (2024)

Allowed in low-risk labour:
✔ Clear liquids
✔ Light snacks
✔ Water, juices, tea

Restrict only if:
❌ High operative risk
❌ GA anticipated
❌ Obesity with difficult airway

Evidence:
No ↑ aspiration risk; better energy + satisfaction.
Outro:
OBG in a Minute.

WHO now allows light eating + liquids during low-risk labour.
Routine fasting → NO longer recommended.
Ref: WHO Intrapartum Care Guidelines 2024.

Contact : 9908384060
anita.nelakuditi@gmail.com

16/02/2026

The latest 2024 & 2025 updates change everything you thought you knew about diagnosing Polycystic O***y Syndrome in young girls.

The old way of using ultrasounds is often inaccurate for teenagers because their ovaries are naturally active and "multifollicular." Here is the correct, updated path to diagnosis:

Focus on the "Phenotype": Diagnosis should be based on physical symptoms and blood work, not just an ultrasound.

The 2-Year Waiting Period: Irregular periods are only a diagnostic marker if they continue for 2 years or more after the very first period (menarche).

Identify Hyperandrogenism: Look for clinical signs (like persistent acne or excess body hair) or biochemical markers in blood tests.

What to Ignore: In adolescents, doctors should not rely on:

Ultrasound PCO morphology (o***y appearance)

LH-FSH ratios

AMH (Anti-Mullerian Hormone) levels

Insulin levels

By following these stricter guidelines, we prevent the unnecessary use of medications like Metformin or Birth Control Pills and avoid the stress of a lifelong "label" during a girl's developing years.

12/02/2026

REDUCED FETAL MOVEMENTS (RFM)
What every PG & clinician must do — 2025 updates
Slide 2 — Definition
RFM = Decrease or change from the baby’s usual pattern.
NOT a fixed number of kicks anymore.
(Updated in RCOG 2024 + ISA 2025)
Slide 3 — When to Evaluate Immediately
Antenatal period → ≥ 28 weeks
Evaluate ASAP if:
Mother feels “baby not moving like before”
No movements for >2 hours
Movements slower / weaker / less frequent
ANY concern from the mother
👉 Maternal perception is highly sensitive.
Slide 4 — Initial Assessment (within 2 hours)
✔ CTG/NST
✔ Maternal vitals
✔ Check for risk factors:
FGR
Hypertension
Diabetes
Smoking
Placental insufficiency history
Slide 5 — If CTG is Normal → Do Ultrasound
Do within 24 hours:
Growth scan
Amniotic fluid
Placental grading (if clinically indicated)
Dopplers if growth concerns
(Stillbirths commonly linked with placental disease)
Slide 6 — DO NOT
❌ Do NOT reassure without CTG
❌ Do NOT tell mothers “it’s normal in late pregnancy”
❌ Do NOT wait 24 hours for assessment
❌ Do NOT use kick charts alone
❌ Do NOT discharge without counselling
Slide 7 — If Recurrent RFM
Higher risk of:
Stillbirth
FGR
Placental insufficiency
Manage with: ✔ Growth scan
✔ Dopplers
✔ Consultant-led review
✔ Consider delivery if concerns persist
Slide 8 — Delivery Criteria
Consider early delivery if:
Abnormal CTG
FGR + abnormal Dopplers
Oligohydramnios
Recurrent RFM + borderline tests
Other maternal risk factors
Slide 9 — Counselling (crucial)
Advise mother to monitor:
“Pattern change”
“Strength change”
“Slowing down”
“Baby unusually quiet”
Tell her:
“Don’t wait — come immediately.”
Slide 10 — Quick Takeaway
Maternal perception is the FIRST and BEST warning sign.
Early assessment can prevent stillbirth.

09/02/2026

Latest 2025 update from the Society of Maternal & Fetal Medicine (SMFM) on Fetal Growth Restriction (FGR) explained clearly in just a minute.
Early diagnosis, proper monitoring, and evidence-based management are key to improving fetal outcomes. Stay updated with current guidelines to ensure safer pregnancies and healthier babies.

Contact : 9908384060
anita.nelakuditi@gmail.com





05/02/2026

Modern Safety Understanding
Updated Safety Data 2022–2024
Multiple meta-analyses show no increased risk of:
Cardiac anomalies
Orofacial clefts
Limb defects
Spontaneous abortion
When to AVOID
G6PD deficiency → risk of maternal hemolysis.
At or near term (38–42 weeks) → neonatal hemolytic anemia & jaundice.
Suspected pyelonephritis → nitrofurantoin does not achieve renal tissue levels → avoid.

Updated Dose Recommendations (2023–2025)
For Asymptomatic Bacteriuria
Nitrofurantoin 100 mg BID × 5–7 days
For Acute Cystitis
Nitrofurantoin 100 mg BID × 7 days
For Suppressive/Prophylactic Therapy
(For recurrent UTIs in pregnancy)
Nitrofurantoin 100 mg HS daily
New: Single-dose therapy?
No — remains not recommended in pregnancy (SPACE regimen contraindications)

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