An Outstanding Free Quick Reference for Obstetrics

Many of us in family medicine practice full-scope including obstetrics and urgent/emergent care. This is one of the most rewarding aspects of the specialty, but also one of the most challenging with very unpredictable hours and significant medical-legal risk. Routine vaginal deliveries can quickly deteriorate into one of many frightening obstetrical emergencies. Recent data from the CDC show a sobering statistic that maternal mortality in the U.S. is increasing — not decreasing. The number of reported pregnancy-related deaths in the U.S steadily increased from 7.2 deaths per 100,000 live births in 1987 to 18.0 deaths per 100,000 live births in 2014. Multiple media outlets have recently been reporting on this trend including a 6-month expose by National Public Radio and ProPublica which highlights numerous stories and the CDC data. 

Many family physicians and even some obstetricians and midwives have completed the outstanding Advanced Life Support in Obstetrics (ALSO) course. This two-day course covers many of the common obstetrical emergencies. Unfortunately, ALSO has no medical app, but rather good but not great pocket cards. 

Here on iMedicalApps, we have reviewed other ob/gyn apps that include some information on obstetrics. One of my perennial favorites has been the excellent combination app by Mark Brancel, MD, PrenatalOB/UrgentOB/NewbornCare. However, since these guides became a web-only platform, I have not found them to be nearly as easy to use as their previous iOS-dedicated app formats. We also favorably reviewed the app from the Safe Motherhood Initiative. Other comprehensive OB apps include the Johns Hopkins OB Guide, Washington University OBGYNManual, and numerous OB wheel/OB tracker (both are excellent) and contraception apps (love the Steinberg Contraception app!). 

In fact, I have far more targeted OB apps then complete/comprehensive apps. 

Certainly, providers can and should refer to UpToDate and Dynamed as well as ACOG’s own app for many OB related questions. The latest and most comprehensive obstetrics-only app outside of UpToDate/Dynamed comes from the makers of the Merck Manual. Called the MSD Manual outside of the U.S., the MSD Manual Guide to Obstetrics is an abridged Merck Manual focused on OB. The app has nearly 100 OB topics written by an international staff of writers. Each topic is formatted similarly and includes overviews, signs/symptoms, diagnosis, treatment, key points, and date of authorship. It should still be viewed as a quick reference guide as the sections are not extensive. The app does contain many outstanding videos (especially for OB emergencies), tables, figures, and references. All content is fully downloaded to the device as well. 

Evidence-Based Medicine

The MSD Manual Guide to Obstetrics app is the product of the Merck corporation. It is an abridged version of the MSD/Merck Professional Manual. The information in the app is a combination of expert opinion, references to ACOG position statements/practice bulletins, and treatment algorithms supported by evidence-based medicine, clinical practice guidelines and standard of care medical practice. The app covers nearly 100 different topics and appears to be free of bias despite its origins. The app claims to be updated monthly, but most topics appeared to be several months since their last update.

What providers would benefit from this App?

Students, residents, nurses, family medicine, midwives, ob/gyn, Emergency Medicine and any provider who performs obstetrics.

Price

o App is free

Likes

o Covers nearly 100 topics with quality articles, videos, tables, etc

o All content fully downloaded to device

o Available for Android

Dislikes

o App interface needs work: wasted space, small fonts, organizational puzzles

o No information on COVID-19 and maternal care

o Some sections without references or only a video for content (i.e., neonatal resuscitation)

Overall

The MSD Manual Guide to Obstetrics is an excellent pocket-guide for any provider who performs obstetrics.  Although the app may lack the evidence-based rigor of UpToDate or Dynamed, it provides numerous references to ACOG bulletins, and other references throughout the 99 core topics contained in the app. Each topic has been updated within the past year (but few this month, for example) and written by clinician experts associated with Merck. The app contains an extensive explanation of Merck’s involvement and no evidence of bias is noted. The app covers everything from prenatal genetic testing to neonatal resuscitation. All of this content is available for free.

Overall Score

o 4.5 stars

User Interface

o 4.0 stars

Lots of wasted space on some screens and overall look and organization needs some improvement, but usable nonetheless.

Multimedia Usage

o 5.0 stars

App is filled with videos (with high fidelity simulators), images, figures, tables and calculators…all content fully downloaded onto your device.       

Price

o 5.0 stars

App is free.

Real-World Applicability

o 5.0 stars

The MSD Manual Guide to Obstetrics from Merck is an excellent free app covering nearly 100 core OB topics. The app includes high quality videos covering all the common obstetrical emergencies and (mostly, nothing on COVID for example) up to date content from an international list of authors/contributors. The apps look and organization could be improved upon, but that is really a small gripe for the amount of free content available. 

Device Used For Review

o iPhone 11 Pro running iOS 13.5

Available for iPhone/iPad and Android.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense, or the U.S. Government.