The Fellow Forge - O&G

A 33-year-old with type 2 diabetes, a BMI of 37 and five medicines wants to start trying next month. We follow her through nine months of getting ready for pregnancy, with a second woman on valproate and a thyroid variant for the viva.

In this episode:
• Why this visit matters more than booking, and the identify, optimise, plan structure
• Diabetes before conception: HbA1c targets, stopping semaglutide, ACE inhibitors and statins, and checking eyes and kidneys
• Folate doses, iodine, weight, smoking and alcohol
• Rubella and varicella vaccination, the 28-day rule, and vaccines in pregnancy
• Reproductive carrier screening for cystic fibrosis, SMA and fragile X
• Switching from valproate, and raising thyroxine the day the test is positive

A study discussion for O&G trainees, not clinical advice. Check your local guidelines.

A baby born white and limp after a difficult ventouse, with the paediatrician next door. The obstetric registrar starts resuscitation. In the next room, a 29-week baby needs a gentler start.

In this episode:
• Drying, warmth, airway and breaths in the first minute
• Fixing ventilation with MR SOPA
• Compressions, adrenaline and fluids under current ANZCOR guidance
• Oxygen and saturation targets by time and gestation
• Preterm stabilisation: cord clamping, plastic wrap and CPAP
• Cord gases, Apgars, cooling criteria and when to stop

A study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.

At 38 weeks, a midwife can't find the heartbeat. We follow a family through telling, birth, investigation, review and the next pregnancy, with the definitions and data examiners ask about.
In this episode:
• Breaking bad news, induction and bereavement care
• The PSANZ core investigations and consent for autopsy
• PSANZ-PDC classification (2024) and perinatal mortality review
• Open disclosure
• Maternal death definitions and the latest Australian data
• Care in the next pregnancy
A study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.

A mum with a 14-month-old is unexpectedly pregnant again, and asks to have her tubes tied at the caesarean. Contraception timing after birth, and counselling for sterilisation.

In this episode:
• Lactational amenorrhoea and why ovulation comes back before the first period
• IUD timing: within 48 hours, or from 4 weeks
• Combined hormonal contraception after birth under UKMEC 2025
• Salpingectomy versus clips, regret, capacity and vasectomy
• Emergency contraception while breastfeeding

A study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.

Day ten at home, a gush and a clot the size of a lemon. In the same week, another woman has constant leakage after a difficult caesarean. Secondary PPH and the complications that show up after discharge.

In this episode:
• Secondary PPH: causes, hCG, ultrasound with Doppler, and AVM and pseudoaneurysm
• Evacuating retained products safely, and Asherman syndrome
• Ureteric injury versus bladder fistula: the dye test and the creatinine clue
• Episiotomy breakdown, incontinence and painful sex in the months after birth

A study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.

A woman stopped her sertraline when the pregnancy test was positive. Two doors down on the postnatal ward, a woman with bipolar disorder becomes psychotic on day four. Screening, medicines and the conditions examiners expect you to tell apart.

In this episode:
• Antidepressants in pregnancy and the risks of stopping them
• EPDS screening under COPE 2023, including item ten
• Birth trauma, PTSD and debriefing
• The blues, perinatal OCD and postpartum psychosis, and how to tell them apart
• Lithium, bipolar disorder and mother–baby units
• Safety planning and where to get help

A study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.

Day five after a caesarean, she stops mid-feed with pleuritic pain. The same week, a woman at 29 weeks has a swollen left leg and a normal ultrasound. Preventing, diagnosing and treating clots in pregnancy.

In this episode:
• Risk assessment and postnatal enoxaparin, including weight-banded doses
• Why a D-dimer doesn't help, and treating before imaging
• V/Q scan versus CT pulmonary angiogram, and breastfeeding
• Massive PE, iliac vein clots and neuraxial timing
• Warfarin and breastfeeding, contraception and the next pregnancy

A study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.

Day three after an emergency caesarean, with fever and offensive lochia. In the next bay, group A strep septic shock on day one. Recognising maternal sepsis and treating it well.

In this episode:
• Why pregnancy changes masks sepsis, and the warning signs that cut through
• The first hour: cultures, antibiotics and fluids
• Endometritis, the non-responder and septic pelvic thrombophlebitis
• Group A strep: clindamycin, immunoglobulin and contact prophylaxis
• Mastitis under the 2022 Academy of Breastfeeding Medicine protocol, and breast abscess

A study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.

A country hospital phones about a first-time mum in labour at twenty-three weeks. We follow her through transfer, counselling with the neonatal team, labour and birth, and then plan her next pregnancy.

In this episode:

• In-utero transfer: steroids, magnesium and GBS cover before she leaves

• Periviability counselling, current ANZNN survival data and state-based frameworks

• Mode of birth and caesarean decisions at the edge of viability

• Monitoring a very preterm baby, and why some interventions are avoided

• Delayed cord clamping, keeping the baby warm, and antibiotics for preterm prelabour rupture

• Preventing preterm birth next time

A study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.

A GBS-positive first-time mum spikes a temperature at seven centimetres. Meanwhile, in the next room, a woman collapses. Two intrapartum emergencies, start to finish.

In this episode:

• GBS prophylaxis, the four-hour rule and penicillin allergy

• Epidural fever versus infection, and the definition and management of chorioamnionitis

• Thick meconium: no amnioinfusion, and no routine suction of a vigorous baby

• The baby's sepsis work-up after maternal fever

• Maternal collapse, resuscitative hysterotomy and amniotic fluid embolism

A study discussion for FRANZCOG trainees, not clinical advice. Check your local guidelines.