General Obstetrics: Antepartum, Intrapartum, and Postpartum Care
Core concepts
General obstetrics rewards a time-anchored, gestational-age-based approach. Know the schedule of prenatal visits, routine labs (CBC, blood type and antibody screen, Rh status, infectious disease screening, glucose tolerance testing), and the aneuploidy screening options with their windows. Understand normal labor physiology: the three stages, Friedman-style progress expectations, fetal heart rate interpretation using category I/II/III logic, and the indications for operative vaginal delivery versus cesarean. Postpartum care centers on hemorrhage (the four T's: tone, trauma, tissue, thrombin), hypertension, infection, and thromboembolism, plus lactation and contraception counseling.
Traps
- Dating vs. sizing discrepancy: early ultrasound is the most accurate dating tool; do not re-date later unless the discrepancy exceeds accepted thresholds.
- Rh prophylaxis timing: routine anti-D at ~28 weeks and within 72 hours postpartum for Rh-negative unsensitized patients; a weak D or partial D result changes management.
- Group B strep: prophylaxis is indicated in labor for colonization, prior GBS-affected infant, or unknown status with risk factors-not for elective cesarean before labor.
- Postpartum hemorrhage: quantify blood loss and treat uterine atony first; do not anchor on a single cause.
- Preeclampsia without proteinuria can still be diagnosed with severe features (e.g., thrombocytopenia, renal or hepatic dysfunction, pulmonary edema, new headache/visual symptoms).
Worked example / rule of thumb
A patient at 39 weeks has a Category II tracing with recurrent late decelerations. Rule of thumb: Category II requires evaluation and intrauterine resuscitation (position change, oxygen, IV fluids, stop oxytocin), and persistent late decelerations with minimal variability suggest uteroplacental insufficiency warranting delivery planning. Never treat a Category III tracing expectantly.
Study strategy
Build a one-page timeline of prenatal care and a one-page labor progress algorithm; these two artifacts cover most general-obstetrics stems.